Aortic dissection - Knowledge (XXG)

1127:(TEE) is a good test in the diagnosis of aortic dissection, with a sensitivity up to 98% and a specificity up to 97%. It has become the preferred imaging modality for suspected aortic dissection. It is a relatively noninvasive test, requiring the individual to swallow the echocardiography probe. It is especially good in the evaluation of AI in the setting of ascending aortic dissection and to determine whether the ostia (origins) of the coronary arteries are involved. While many institutions give sedation during transesophageal echocardiography for added patient comfort, it can be performed in cooperative individuals without the use of sedation. Disadvantages of TEE include the inability to visualize the distal ascending aorta (the beginning of the 1097: 1015: 1088: 2974:"2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine" 1401:

aortic dissections often involve the aortic valve, which, having lost its suspensory support, telescopes down into the aortic root, resulting in aortic incompetence. The valve must be resuspended to be reseated, as well as to repair or prevent coronary artery injury. Also, the area of dissection is removed and replaced with a Dacron graft to prevent further dissection from occurring. However, type B dissections are not improved, from a mortality point of view, by the operation, unless leaking, rupture, or compromise to other organs, e.g. kidneys, occurs.

796: 792:, so a retrograde dissection can easily compromise the pericardium leading to a hemopericardium. Anterograde dissections may propagate all the way to the iliac bifurcation of the aorta, rupture the aortic wall, or recanalize into the intravascular lumen leading to a double-barrel aorta. The double-barrel aorta relieves the pressure of blood flow and reduces the risk of rupture. Rupture leads to hemorrhaging into a body cavity, and prognosis depends on the area of rupture. Retroperitoneal and pericardial ruptures are both possible. 1027: 1066:(MRI) is also used for the detection and assessment of aortic dissection, with a sensitivity of 98% and a specificity of 98%. An MRI examination of the aorta produces a three-dimensional reconstruction of the aorta, allowing the physician to determine the location of the intimal tear and the involvement of branch vessels, and to locate any secondary tears. It is a noninvasive test, does not require the use of iodinated contrast material, and can detect and quantitate the degree of aortic insufficiency. 1003: 56: 1288: 1430:

individual presents within the first two weeks. If the individual has managed to survive this window period, their prognosis is improved. About 66% of all dissections present in the acute phase. Individuals who present two weeks after the onset of the dissection are said to have chronic aortic dissections. These individuals have been self-selected as survivors of the acute episode and can be treated with medical therapy as long as they are stable.

1281: 1613: 1558:-reinforced Dacron graft: The vascular ring connector is a titanic ring used as a stent in the vascular graft to achieve a quick, blood-sealed, and sutureless anastomosis. Two furrows on the surface of the ring are for fixation of the vascular graft and the aorta. The tapes used to tie against the ring provide a larger contact surface area than the traditional stitches, thus it provides stronger anastomosis and better surgical results. 753: 916: 1043: 1274: 1695:

Establishing the incidence of aortic dissection has been difficult because many cases are only diagnosed after death (which may have been attributed to another cause), and is often initially misdiagnosed. Aortic dissection affects an estimated 2.0–3.5 people per every 100,000 every year. Studies from

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The objective in the surgical management of aortic dissection is to resect (remove) the most severely damaged segments of the aorta and to obliterate the entry of blood into the false lumen (both at the initial intimal tear and any secondary tears along the vessel). While excision of the intimal tear

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The main indication for surgical repair of type A dissections is the prevention of acute hemorrhagic pericardial tamponade due to leakage of blood through the dissected layers of the intrapericardial proximal aorta. A secondary indication is acute aortic valve insufficiency (regurgitation): ascending

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method. This type of scan is timed to injection to capture the contrast as it enters the aorta. The scan then follows the contrast as it flows through the vessel. It has a sensitivity of 96 to 100% and a specificity of 96 to 100%. Disadvantages include the need for iodinated contrast material and the

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have been associated with a subsequent aortic dissection. Marfan Syndrome is found in 5–9% of individuals who had an aortic dissection. In this subset, the incidence in young individuals is increased. Individuals with Marfan syndrome tend to have aneurysms of the aorta and are more prone to proximal

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The risk of death is highest in the first two years after the acute event, and individuals should be followed closely during this time period. About 29% of late deaths following surgery are due to rupture of either a dissecting aneurysm or another aneurysm. In addition, a 17% to 25% incidence exists

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Repair of an enlargement of the ascending aorta from an aneurysm or previously unrecognized and untreated aortic dissections is recommended when greater than 5.5 cm (2.2 in) in size to decrease the risk of dissection. Repair may be recommended when greater than 4.5 cm (1.8 in) in

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Severe hypotension at presentation is a grave prognostic indicator. It is usually associated with pericardial tamponade, severe aortic insufficiency, or rupture of the aorta. Accurate measurement of blood pressure is important. Pseudohypotension (falsely low blood-pressure measurement) may occur due

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Indications for the surgical treatment of aortic dissection include an acute proximal aortic dissection and an acute distal aortic dissection with one or more complications. Complications include compromise of a vital organ, rupture or impending rupture of the aorta, retrograde dissection into the

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is a fast, non-invasive test that gives an accurate three-dimensional view of the aorta. These images are produced by taking rapid, thin-cut slices of the chest and abdomen, and combining them in the computer to create cross-sectional slices. To delineate the aorta to the accuracy necessary to make

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While taking a good history from the individual may be strongly suggestive of an aortic dissection, the diagnosis cannot always be made by history and physical signs alone. Often, the diagnosis is made by visualization of the intimal flap on a diagnostic imaging test. Common tests used to diagnose

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of the media apart along the laminated plane splitting the inner two-thirds and the outer one-third of the media apart. This can propagate along the length of the aorta for a variable distance forward or backward. Dissections that propagate towards the iliac bifurcation (with the flow of blood) are

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Several different classification systems have been used to describe aortic dissections. One such classification is based on chronicity and labels aortic dissections as hyperacute (<24 hours duration), acute (2–7 days), subacute (8–30 days), and chronic (>30 days). The systems commonly in use

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The disadvantage of the MRI scan in the face of aortic dissection is that it may be available only in larger hospitals, and the scan is relatively time-consuming, which could be dangerous in people who are already very unwell. Due to the high-intensity magnetic fields used during MRI, it cannot be

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In an acute dissection, treatment choice depends on its location. For Stanford type A (ascending aortic) dissection, surgical management is superior to medical management. For uncomplicated Stanford type B (distal aortic) dissections (including abdominal aortic dissections), medical management is

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AD is relatively rare, occurring at an estimated rate of three per 100,000 people per year. It is more common in men than women. The typical age at diagnosis is 63, with about 10% of cases occurring before the age of 40. Without treatment, about half of people with Stanford type A dissections die

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The risk of death due to aortic dissection is highest in the first few hours after the dissection begins, and decreases afterward. Because of this, the therapeutic strategies differ for the treatment of an acute dissection compared to a chronic dissection. An acute dissection is one in which the

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The initiating event in aortic dissection is a tear in the intimal lining of the aorta. Due to the high pressures in the aorta, blood enters the media at the point of the tear. The force of the blood entering the media causes the tear to extend. It may extend proximally (closer to the heart) or

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About 96% of individuals with AD present with severe pain that had a sudden onset. The pain may be described as a tearing, stabbing, or sharp sensation in the chest, back, or abdomen. About 17% of individuals feel the pain migrate as the dissection extends down the aorta. The location of pain is

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Of all people with aortic dissection, 40% die immediately and do not reach a hospital in time. Of the remainder, 1% die every hour, making prompt diagnosis and treatment a priority. Even after diagnosis, 5–20% die during surgery or in the immediate postoperative period. In ascending aortic

1347:, is an anatomical description of the aortic dissection. It categorizes the dissection based on where the original intimal tear is located and the extent of the dissection (localized to either the ascending aorta or descending aorta or involving both the ascending and descending aorta). 1146: 1732:

contributed to the understanding of the condition by publishing two series of the cases described in the literature so far: 19 cases in an 1843 review, and 80 in 1863. The characteristic symptom of tearing pain in the chest was recognized in 1855 when a case was diagnosed in life.

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The Stanford classification is useful as it follows clinical practice, as type A ascending aortic dissections generally require primary surgical treatment, whereas type B dissections generally are treated medically as initial treatment with surgery reserved for any complications.

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Sweden suggest that the incidence of aortic dissection may be rising. Men are more commonly affected than women: 65% of all people with aortic dissection are male. The mean age at diagnosis is 63 years. In females before the age of 40, half of all aortic dissections occur during

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was diagnosed with dissecting aortic aneurysm and underwent surgery to repair her aorta and a successful seven-hour aortic valve replacement, but died days later. A greater incidence of aortic aneurysm is seen in cigarette smokers; Ball had been a heavy smoker most of her life.

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for better anatomical images. Other tests that may be used include an aortogram or magnetic resonance angiogram of the aorta. Each of these tests has pros and cons, and they do not have equal sensitivities and specificities in the diagnosis of aortic dissection.

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level may be useful in diagnostic evaluation. A level less than 500 ng/ml may be considered evidence against a diagnosis of aortic dissection, although this guideline is only applicable in cases deemed "low risk" and within 24 hours of symptom onset. The

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Prevention is by blood pressure control and smoking cessation. Management of AD depends on the part of the aorta involved. Dissections that involve the first part of the aorta (adjacent to the heart) usually require surgery. Surgery may be done either by an

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of an artery) is rarely associated with aortic dissection. It can also be the result of chest trauma. About 72 to 80% of individuals who present with an aortic dissection have a previous history of hypertension. Illicit drug use with stimulants such as

245: 615:) can be due to either blood from a transient rupture of the aorta or fluid due to an inflammatory reaction around the aorta. If a pleural effusion were to develop due to AD, it is more common in the left hemithorax rather than the right hemithorax. 1148: 1220: 1201: 1183: 1165: 4189:"Kentaro Miura passed away on May 6, 2021, from acute aortic dissection. He was 54. Miura-sensei was a master artist and storyteller and we had the great privilege of publishing several of his finest works, including his masterpiece, Berserk" 5140: 5125: 1454:, or the lowest blood pressure tolerated. Initial decreases should be by about 20%. The target heart rate is less than 65 beats per minute. Long-term blood pressure control is required for every person who has experienced aortic dissection. 259: 257: 260: 256: 255: 254: 1501:

If the individual has refractory hypertension (persistent hypertension on the maximum doses of three different classes of antihypertensive agents), involvement of the renal arteries in the aortic dissection plane should be considered.

663:) is found in 7–14% of individuals who have an aortic dissection. These individuals are prone to dissection in the ascending aorta. The risk of dissection in individuals with bicuspid aortic valves is not associated with the degree of 966:

Importantly, about 12 to 20% of aortic dissections are not detectable by chest radiograph; therefore, a "normal" chest radiograph does not rule out aortic dissection. If there is high clinical suspicion, a more sensitive imaging test

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preferred over surgery. Complicated Stanford type B aortic dissections require surgical intervention after initiation of medical therapy, with endovascular stent-grafting (TEVAR) available as a less invasive alternative to surgery.

261: 564:, preventing the leaflets of the valve from coapting. The dissection may extend into the aortic root and detach the aortic valve leaflets. Alternatively, following an extensive intimal tear, the intimal flap may prolapse into the 1386:– involves the ascending aorta and/or aortic arch, and possibly the descending aorta. The tear can originate in the ascending aorta, the aortic arch, or more rarely, in the descending aorta. It includes DeBakey types I and II. 1225: 1224: 1221: 1206: 1205: 1202: 1188: 1186: 1170: 1168: 1226: 1207: 1187: 1169: 518:. The blood pressure is quite variable at presentation with acute AD. It tends to be higher in individuals with a distal dissection. In individuals with a proximal AD, 36% present with hypertension, while 25% present with 1724:, who had been found dead on 25 October 1760; the report describes a dissection of the aortic arch and into the pericardium. The term "aortic dissection" was introduced by the French physician J. P. Maunoir in 1802, and 799:

Histopathological image of dissecting aneurysm of the thoracic aorta in a patient without evidence of Marfan syndrome: The damaged aorta was surgically removed and replaced by artificial vessel, Victoria blue and HE

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died at the Glendale Memorial Hospital on February 4, 2009, at the age of 62, following an aortic dissection which, contrary to initial reports about a pre-existing condition, was "sudden, shocking and unexpected".

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are based on either the anatomy of the dissection or the duration of onset of symptoms before the presentation. The Stanford system is used more commonly now, as it is more attuned to the management of the patient.

403:. Dissections that involve the second part of the aorta can typically be treated with medications that lower blood pressure and heart rate, unless there are complications which then require surgical correction. 1354:– originates in ascending aorta, and propagates at least to the aortic arch and often beyond it distally. It is most often seen in patients less than 65 years of age and is the most lethal form of the disease. 865:

Because of the varying symptoms of aortic dissection, the diagnosis is sometimes difficult to make. Concern should be increased in those with low blood pressure, neurological problems, and an unequal pulses.

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are the first-line treatment for patients with acute and chronic aortic dissection. In acute dissection, fast-acting agents can be given intravenously and have doses that are easier to adjust (such as

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called anterograde dissections and those that propagate towards the aortic root (opposite of the flow of blood) are called retrograde dissections. The initial tear is usually within 100 mm of the

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In general, the imaging technique chosen is based on the pretest likelihood of the diagnosis, availability of the testing modality, patient stability, and the sensitivity and specificity of the test.

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of aortic insufficiency is audible in about 32% of proximal dissections. The intensity (loudness) of the murmur depends on the blood pressure and may be inaudible in the event of low blood pressure.

587:, which supply the heart with oxygenated blood, in the dissection. The right coronary artery is involved more commonly than the left coronary artery. If the myocardial infarction is treated with 1766:, who died from a thoracic aortic dissection in 2003 after he was misdiagnosed and erroneously treated for a heart attack by his two doctors. The rules were developed by Dianna Milewicz of the 1748:, Houston, Texas, in 1954. DeBakey developed aortic dissection himself at age 97 in 2005, and underwent surgery in 2006. Endovascular treatment of aortic dissection was developed in the 1990s. 4244: 1002: 248: 252: 251: 247: 246: 738:

are at particularly high risk because aortic regurgitation causes increased blood flow in the ascending aorta. This can cause dilatation and weakening of the walls of the ascending aorta.

253: 3652:"Thoracic Aortic Aneurysm and Dissection. Increasing Prevalence and Improved Outcomes Reported in a Nationwide Population-Based Study of More Than 14 000 Cases From 1987 to 2002" 483:. If the individual fainted, about half the time it is due to bleeding into the pericardium, leading to pericardial tamponade. Neurological complications of aortic dissection, such as 1947: 1113:

and false lumen of an aortic dissection: In the image to the left, the intimal flap can be seen separating the two lumens. In the image to the right, color flow during ventricular

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dissection, if surgery is decided to be not appropriate, 75% die within 2 weeks. With aggressive treatment, 30-day survival for thoracic dissections may be as high as 90%.

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can be used in the treatment of aortic dissection, particularly if a contraindication to the use of beta-blockers exists. The calcium channel blockers typically used are

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is difficult if the cause is an intramural hematoma. An aortic dissection secondary to an intramural hematoma should be treated the same as one caused by an intimal tear.

250: 734:. About 18% of individuals who present with an acute aortic dissection have a history of open-heart surgery. Individuals who have undergone aortic valve replacement for 428:

chest pain is associated with dissections involving the ascending aorta, while interscapular back pain is associated with descending aortic dissections. If the pain is

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Ritter Rules are a compilation of reminders, symptoms, and risk factors designed to prevent the misdiagnosis of thoracic aortic dissection. The rules were named after

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seven years after Ritter's premature death, and were jointly published by the non-profit organization in Ritter's honor and the Thoracic Aortic Disease Coalition.

3889: 1392:– involves the descending aorta or the arch (distal to the left subclavian artery), without the involvement of the ascending aorta. It includes DeBakey type III. 1222: 1203: 1026: 1628:

of new aneurysm formation, typically due to dilatation of the residual false lumen. These new aneurysms are more likely to rupture, due to their thinner walls.

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An aortogram involves the placement of a catheter in the aorta and injection of contrast material while taking X-rays of the aorta. The procedure is known as

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Shimony A, Filion, KB, Mottillo, S, Dourian, T, Eisenberg, MJ (2011-04-15). "Meta-analysis of usefulness of d-dimer to diagnose acute aortic dissection".

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within three days and about 10% of people with Stanford type B dissections die within one month. The first case of AD was described in the examination of

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As blood flows down the false lumen, it may cause secondary tears in the intima. Through these secondary tears, the blood can re-enter the true lumen.

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The long-term follow-up in individuals who survive aortic dissection involves strict blood pressure control. The relative risk of late rupture of an

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may although demonstrate a change in the morphology of the thoracic aorta which can be seen in aortic dissection. Classically, new widening of the

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Kamman AV, Yang B, Kim KM, Williams DM, Michael Deeb G, Patel HJ (2017). "Visceral Malperfusion in Aortic Dissection: The Michigan Experience".

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In about 13% of aortic dissections, no evidence of an intimal tear is found. In these cases, the inciting event is thought to be an intramural

780:; the media contains connective and muscle tissue, and the vessel is protected on the outside by the adventitia, comprising connective tissue. 4688: 4307: 3983: 3706: 3026: 2867: 2567: 2300: 2273: 2246: 991:

the proper diagnosis, an iodinated contrast material is injected into a peripheral vein. Contrast is injected and the scan performed using a

569: 1366:– originates in the descending aorta and rarely extends proximally, but will extend distally. It most often occurs in elderly patients with 1096: 4693: 4269: 3116: 949:

The "calcium sign" describes an apparent separation of the intimal calcification from the outer aortic margin by greater than 10 mm.

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had an aortic aneurysm on September 27, 2021, in the middle of the final song of their 50-minute set at a music festival. He underwent

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is 10 times higher in individuals who have uncontrolled hypertension, compared to individuals with a systolic pressure below 130 mmHg.

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A number of comorbid conditions increase the surgical risk of repair of an aortic dissection. These conditions include the following:

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Aortic dissection generally presents as a hypertensive emergency, and the prime consideration of medical management is to decrease the

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Wanga S, Silversides C, Dore A, de Waard V, Mulder B (January 2016). "Pregnancy and Thoracic Aortic Disease: Managing the Risks".

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can be considered for people with ongoing high blood pressure, but they should never be used alone, as they often stimulate a

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Chest trauma leading to aortic dissection can be divided into two groups based on cause: blunt chest trauma (commonly seen in

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White A, Broder J, Mando-Vandrick J, Wendell J, Crowe J (2013). "Acute aortic emergencies – part 2: aortic dissections".

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The Stanford classification is divided into two groups, A and B, depending on whether the ascending aorta is involved.

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Bossone E, Suzuki T, Eagle KA, Weinsaft JW (May 2013). "Diagnosis of acute aortic syndromes: imaging and beyond".

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used to confirm and further evaluate the dissection. The two main types are Stanford type A, which involves the

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size if the person has one of the several connective-tissue disorders or a family history of a ruptured aorta.

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The particular treatment used depends on the segment or segments of the aorta involved. Some treatments are:

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CT with contrast demonstrating aneurysmal dilation and a dissection of the ascending aorta (type A Stanford)

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In an aortic dissection, blood penetrates the intima and enters the media layer. The high pressure rips the

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Multiple causes exist for AI in the setting of ascending AD. The dissection may dilate the annulus of the

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and is most commonly associated with Marfan syndrome and is also associated with Ehlers-Danlos syndrome.

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While it is not always clear why an intimal tear may occur, quite often it involves degeneration of the

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therapy, the mortality increases to over 70%, mostly due to bleeding into the pericardial sac, causing

772:. The intima is in direct contact with the blood inside the vessel, and mainly consists of a layer of 4983: 4978: 4782: 4574: 4192: 4108: 4080: 2893:"Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome" 1473: 1253: 735: 694: 690: 550: 285: 170: 1511:

ascending aorta. These are more common with a history of Marfan syndrome or Ehlers-Danlos syndrome.

962:, depression of the left mainstem bronchus, loss of the paratracheal stripe, and tracheal deviation. 5144: 5059: 4826: 2850:

Cook JR, Ramirez F (2014). "Clinical, diagnostic, and therapeutic aspects of the Marfan syndrome".

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Stankowski RV, Kloner RA, Rezkalla SH (August 2015). "Cardiovascular consequences of cocaine use".

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Woo KM, Schneider JI (November 2009). "High-risk chief complaints I: chest pain – the big three".

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Alfson DB, Ham SW (August 2017). "Type B Aortic Dissections: Current Guidelines for Treatment".

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are also associated with an increased risk. The diagnosis is suspected based on symptoms with

197: 88: 2290: 1135:. A TEE may be technically difficult to perform in individuals with esophageal strictures or 4769: 4418: 3826: 3818: 3770: 3731: 3663: 3624: 3544: 3528: 3459: 3418: 3256: 3219: 3180: 3143: 2985: 2941: 2904: 2855: 2824: 2789: 2747: 2737: 2555: 2520: 2480: 2437: 2374: 2329: 2207: 2197: 2153: 2085: 2015: 952: 927: 825: 604: 384: 93: 64: 4188: 3855: 2318:"Cardiac Tamponade Complicating Proximal Aortic Dissection. Is Pericardiocentesis Harmful?" 1612: 300:

may also occur. Damage to other organs may result from the decreased blood supply, such as

4961: 4956: 4868: 4591: 4546: 4426: 4013: 2854:. Advances in Experimental Medicine and Biology. Vol. 802. Springer. pp. 77–94. 2546:

Di Tullio MR, Homma S (2016-01-01), Grotta JC, Albers GW, Broderick JP, Kasner SE (eds.),

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Serial imaging of the aorta is suggested, with MRI being the preferred imaging technique.

1621: 1551:, a minimally invasive surgical procedure usually combined with ongoing medical management 1542: 1446:)) by decreasing blood pressure and the heart rate. The target blood pressure should be a 1367: 1110: 813: 731: 705: 674: 664: 645: 584: 388: 372: 328: 297: 202: 174: 166: 118: 76: 72: 3132:"Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis" 1725: 907:

does not advise using this test in making the diagnosis, as evidence is still tentative.

1545:– replacement of the damaged section of the aorta and reimplantation of the aortic valve 805:

distally (away from the heart) or both. The blood travels through the media, creating a

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with replacement of the damaged section of the aorta with a tube graft (often made of

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and then taken into surgery, but was pronounced dead at 10:48 p.m., at the age of 54

1741: 1539:– replacement of the damaged section of the aorta and replacement of the aortic valve 1457: 1070:

used on individuals with metallic implants. In addition, some individuals experience

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The vast majority of aortic dissections originate with an intimal tear in either the

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occurs in 1–2% of aortic dissections. Infarction is caused by the involvement of the

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NZ cricket great Chris Cairns on life support in Australia after major medical event

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DeBakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr (Jan 1965).

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Nienaber CA, Clough RE (28 February 2015). "Management of acute aortic dissection".

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died on May 22, 2004, at the age of 44 due to complications from aortic dissection.

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may be imminent. Pericardial tamponade is the most common cause of death from AD.

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Practice Committee of the American Society for Reproductive Medicine (Nov 2006).

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National Center for Biotechnology Information, U.S. National Library of Medicine

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National Center for Biotechnology Information, U.S. National Library of Medicine

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National Center for Biotechnology Information, U.S. National Library of Medicine

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National Center for Biotechnology Information, U.S. National Library of Medicine

2589: 2317: 1859: 1841: 1798: 1763: 1465: 1439: 1249: 1243: 1128: 959: 931: 920: 817: 773: 527: 522:. Proximal AD tends to be associated with weakening of the vascular wall due to 519: 437: 293: 157: 114: 80: 3735: 3584: 3361: 3328: 2932:

Kamalakannan D, Rosman HS, Eagle KA (October 2007). "Acute aortic dissection".

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Closure of the lumen of a Type B aortic dissection following medical management

915: 491:, are due to the involvement of one or more arteries supplying portions of the 5239: 5223: 5134: 5000: 4990: 4951: 4895: 4888: 4718: 4217: 4137: 3628: 3260: 3017:

Das M, Mahnken AH, Wildberger JE (2008). Seidensticker PR, Hofmann LK (eds.).

2945: 2828: 2793: 2524: 2441: 2202: 1834: 1701: 938:

for detecting an ascending aortic dissection; however, this finding is of low

716: 632: 476: 5182: 3540: 2334: 1566:

Prolonged preoperative evaluation (increased length of time prior to surgery)

5212: 4754: 4495: 4431: 4387: 4370: 4365: 3102:

The Netter Collection of Medical Illustrations – Integumentary System E-Book

1819: 1697: 1495: 1491: 1487: 1469: 879: 488: 459:

changes. Less common symptoms that may be seen in the setting of AD include

364: 356: 225: 3822: 3774: 3743: 3695:

Ho M, Liang D (2013). "Chapter 11". In Ardehali A, Pérez M, Wang P (eds.).

3677: 3636: 3596: 3558: 3432: 3307: 3268: 3233: 3192: 3157: 2999: 2953: 2918: 2877: 2836: 2801: 2761: 2703: 2669: 2635: 2601: 2532: 2492: 2449: 2388: 2221: 2167: 2097: 2027: 1884:

was put on full life support following an aortic dissection in his home in

955:, more commonly in descending aortic dissections, and typically left-sided. 942:, as many other conditions can cause apparent widening of the mediastinum. 648:

is also a modifiable risk factor for AD. It can also be caused by smoking.

411:

following his death in 1760. Surgery for AD was introduced in the 1950s by

3473: 2343: 4968: 4570: 4507: 4441: 4392: 3840: 3446:

Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE (Sep 1970).

2428:

Orihashi K (May 2016). "Mesenteric ischemia in acute aortic dissection".

1928:, died unexpectedly at home from an aortic dissection, at the age of 60. 1885: 1790:, died in 1996 of an aortic dissection believed to be due to undiagnosed 1712:

The earliest fully documented case of aortic dissection is attributed to

1020:

Chest CT with descending (type B Stanford) aortic dissection (red circle)

850: 835: 741: 708:

also increases the risk of aortic dissection, by aortic root dilatation.

429: 425: 2742: 2235:

Robert O. Bonow, Douglas L. Mann, Douglas P. Zipes, Peter Libby (2011).

685:

increase the risk of aortic dissection. Similarly, vasculitides such as

451:, AD is usually not associated with the other suggestive signs, such as 4203: 4116: 3148: 3131: 2780:

Lech C, Swaminathan A (November 2017). "Abdominal Aortic Emergencies".

2238:

Braunwald's Heart Disease E-Book: A Textbook of Cardiovascular Medicine

1878: 1717: 1461: 1409:

Among the recognized risk factors for aortic dissection, hypertension,

1132: 1042: 899: 871: 839: 641: 376: 352: 348: 190: 5117: 760:

As with all other arteries, the aorta is made up of three layers, the

440:. This is a particularly dangerous eventuality, suggesting that acute 5129: 4361: 1889: 1526: 1256:, it has been supplanted by other, less-invasive imaging modalities. 553:(AI) occurs in half to two-thirds of ascending AD, and the diastolic 484: 468: 301: 130: 3807:"Thomas Bevill Peacock and the early history of dissecting aneurysm" 1736:

Surgery for aortic dissection was first introduced and developed by

1411:

abnormally high levels of lipids (such as cholesterol) in the blood

4705: 2265:

Rosen's Emergency Medicine – Concepts and Clinical Practice E-Book

1611: 1554:

Replacement of the damaged section of the aorta with a sutureless

1548: 1041: 914: 794: 751: 498:

If the AD involves the abdominal aorta, compromise of one or both

288:. In most cases, this is associated with a sudden onset of severe 281: 243: 1855:

died in her car from aortic dissection in 2017 at the age of 57.

1728:

labeled the condition "dissecting aneurysm". London cardiologist

744:

only potentially causes aortic dissection in its tertiary stage.

5160: 4737: 3071: 1451: 608: 572:

into the aortic valve, thereby preventing proper valve closure.

4325: 2184:

Arima D, Suematsu Y, Kurahashi K, Nishi S, Yoshimoto A (2021).

1442:

in the aortic wall (dP/dt (force of ejection of blood from the

1413:, and smoking tobacco are considered preventable risk factors. 2972:

Hiratzka LF, Bakris GL, Beckman JA, et al. (April 2010).

1515:

may be performed, it does not significantly change mortality.

456: 4164:"Taiwanese host Alien Huang's death due to aortic dissection" 1917:

hours of open heart surgery to repair the aortic dissection.

3521:

International Journal of Cardiology, Heart & Vasculature

1158:

Aortic dissection with an intramural hematoma as seen on TEE

284:

allows blood to flow between the layers of the aortic wall,

4270:"Cause of death of Depeche Mode's Andrew Fletcher revealed" 3984:"Lucille Ball, Spirited Doyenne Of TV Comedies, Dies at 77" 3094: 3092: 3884: 3882: 3405:"Surgical management of dissecting aneurysms of the aorta" 3130:

Ohle R, Kareemi HK, Wells G, Perry JJ (18 December 2017).

1360:– originates in the ascending aorta and is confined to it. 1131:), and the descending abdominal aorta that lies below the 945:

There are several other associated radiographic findings:

83:(2) shown in the image are not involved in this condition. 3650:

Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F (2006).

1744:, and Oscar Creech, cardiac surgeons associated with the 1704:

period). Dissection occurs in about 0.6% of pregnancies.

4298:

Demers P, Miller DC (2016). "Type A Aortic Dissection".

2726:"Pleural effusion: diagnosis, treatment, and management" 1874:, died from aortic dissection in 2021 at the age of 54. 1032:

Type A dissection with pericardial effusion as a result.

1343:

The DeBakey system, named after cardiothoracic surgeon

756:

Blood penetrates the intima and enters the media layer.

292:, often described as "tearing" in character. Vomiting, 3759:"Observations concerning the body of his late majesty" 3292:"An Evidence-Based Approach To Acute Aortic Syndromes" 1948:

Isolated Superior Mesenteric Artery Dissection (ISMAD)

230:

Mortality without treatment 10% (type B), 50% (type A)

3583:

Levy D, Goyal A, Grigorova Y, Farci F, Le JK (2023),

3105:(2 ed.). Elsevier Health Sciences. p. 235. 2852:

Progress in Heritable Soft Connective Tissue Diseases

1494:, because of their combined vasodilator and negative 5107: 3485: 3483: 2554:(6th ed.), London: Elsevier, pp. 576–590, 2548:"33 – Atherosclerotic Disease of the Proximal Aorta" 1768:

University of Texas Health Science Center at Houston

1640:

Risk of death in untreated type A aortic dissection

996:

inability to diagnose the site of the intimal tear.

874:

of the chest with iodinated contrast material and a

5192: 5111: 5083: 5018: 5009: 4944: 4904: 4859: 4763: 4745: 4736: 4704: 4664: 4569: 4529: 4506: 4417: 4408: 4378: 4360: 3517:"The ascending aortic aneurysm: When to intervene?" 1232:

Dissection of both the thoracic and abdominal aorta

1213:

Dissection of both the thoracic and abdominal aorta

308:. Aortic dissection can quickly lead to death from 234: 224: 216: 208: 196: 156: 148: 124: 103: 87: 48: 4081:"Alan Thicke's Cause of Death Has Been Confirmed" 4062:"Voodoo Idol: Why Lux Interior Was the Real Deal" 919:Aortic dissection on CXR: Note is made of a wide 327:that affect blood vessel wall strength including 5240:Thoracic Aortic Aneurysms and Aortic Dissections 2690:Mechanic O, Gavin M, Grossman S (9 March 2021). 2361:Sheikh AS, Ali K, Mazhar S (September 3, 2013). 2262:John Marx, Ron Walls, Robert Hockberger (2013). 1844:died in 2016 of type-A aortic dissection at the 1117:suggests that the upper lumen is the true lumen. 424:associated with the location of the dissection. 4009:"TV's Lucille Ball dies of heart failure at 77" 3763:Philosophical Transactions of the Royal Society 3698:A Practical Approach to Cardiovascular Medicine 3591:, Treasure Island (FL): StatPearls Publishing, 2967: 2965: 2963: 2473:Seminars in Thoracic and Cardiovascular Surgery 3800: 3798: 3796: 2316:Isselbacher EM, Cigarroa JE, Eagle KA (1994). 447:While the pain may be confused with that of a 4337: 2506: 2504: 2502: 2135: 2133: 2131: 2129: 2127: 2001: 1999: 1997: 1995: 1993: 1991: 1989: 1987: 1985: 1983: 319:AD is more common in those with a history of 8: 3957:The John Ritter Foundation For Aortic Health 3923:"John Ritter Legacy Lives in 'Ritter Rules'" 3390: 3072:"Aortic Aneurysm, Familial Thoracic 1; AAT1" 2179: 2177: 2125: 2123: 2121: 2119: 2117: 2115: 2113: 2111: 2109: 2107: 2069: 2067: 2065: 1981: 1979: 1977: 1975: 1973: 1971: 1969: 1967: 1965: 1963: 3917: 3915: 3066: 3064: 2782:Emergency Medicine Clinics of North America 2775: 2773: 2771: 2142:"Aortic dissection: a 250-year perspective" 2063: 2061: 2059: 2057: 2055: 2053: 2051: 2049: 2047: 2045: 1700:(typically in the third trimester or early 730:Aortic dissection may be a late sequela of 607:(fluid collection in the space between the 5108: 5015: 4917:Chronic cerebrospinal venous insufficiency 4742: 4414: 4375: 4344: 4330: 4322: 3856:"The Man on the Table Devised the Surgery" 2268:. Elsevier Health Sciences. p. 1125. 2241:. Elsevier Health Sciences. p. 1321. 1252:. Previously thought to be the diagnostic 719:. Iatrogenic causes include trauma during 54: 45: 27:Injury to the innermost layer of the aorta 4300:Sabiston and Spencer Surgery of the Chest 3830: 3667: 3548: 3463: 3422: 3356: 3354: 3323: 3321: 3223: 3147: 2989: 2908: 2751: 2741: 2656:Patibandla S, Heaton J, Azzam JS (2022). 2622:Patibandla S, Heaton J, Azzam JS (2022). 2378: 2333: 2211: 2201: 2157: 842:that make up the media. This is known as 3448:"Management of acute aortic dissections" 1638: 1603:(either acute or chronic kidney failure) 1263: 1959: 1141: 998: 514:People with AD often have a history of 2590:"Anatomy, Thorax, Subclavian Arteries" 1846:Providence Saint Joseph Medical Center 1807:Providence Saint Joseph Medical Center 4689:Hereditary hemorrhagic telangiectasia 3963:from the original on 24 December 2015 3578: 3576: 3574: 3572: 3570: 3568: 1596:Past history of myocardial infarction 1472:) is preferred. Vasodilators such as 623:Aortic dissection is associated with 7: 4694:Generalized essential telangiectasia 3495:The Lecturio Medical Concept Library 3047:The Lecturio Medical Concept Library 1478:reflexive increase in the heart rate 1265:Classification of aortic dissection 1074:while surrounded by the MRI magnet. 878:. The proximity of the aorta to the 310:insufficient blood flow to the heart 212:Blood pressure control, not smoking 4187:Dark Horse Comics (May 20, 2021). 3933:from the original on 5 January 2016 3206:Asha SE, Miers JW (21 March 2015). 1924:, a founding member of the UK band 1549:Thoracic endovascular aortic repair 265:Aortic dissection explanation video 3173:The American Journal of Cardiology 2560:10.1016/b978-0-323-29544-4.00033-5 2077:Advanced Emergency Nursing Journal 63:Stanford type B dissection of the 25: 3894:Thoracic Aortic Disease Coalition 3669:10.1161/CIRCULATIONAHA.106.630400 3225:10.1016/j.annemergmed.2015.02.013 2817:Trends in Cardiovascular Medicine 2380:10.1161/circulationaha.112.000170 1868:, writer and artist of the manga 538:(supplying the right arm) or the 4844:Cerebral venous sinus thrombosis 4268:Beaumont-Thomas B (2022-06-28). 4138:"声優・鶴ひろみさん死去事務所が正式発表運転中に大動脈解離" 3789:from the original on 2015-03-30. 3684:from the original on 2016-08-07. 3314:from the original on 2013-12-04. 3119:from the original on 2017-11-05. 3021:. Heidelberg: Springer Medizin. 3006:from the original on 2013-06-09. 2910:10.1016/j.fertnstert.2006.08.082 2350:from the original on 2016-03-18. 1286: 1279: 1272: 1218: 1199: 1181: 1163: 1144: 1095: 1086: 1053:Aorta descendens with dissection 1025: 1013: 1001: 432:in nature, it may suggest acute 4107:Skinner C (December 13, 2016). 3868:from the original on 2013-09-16 3372:from the original on 9 May 2017 3339:from the original on 9 May 2017 1862:died in 2020 at the age of 36. 1722:King George II of Great Britain 1572:Comorbid disease states (e.g.: 988:Computed tomography angiography 958:Other: the obliteration of the 870:an aortic dissection include a 627:(high blood pressure) and many 502:occurs in 5–8% of cases, while 409:King George II of Great Britain 304:, lower extremity ischemia, or 276:) occurs when an injury to the 4795:Hepatic veno-occlusive disease 3724:Canadian Journal of Cardiology 3515:Saliba E, Sia Y (2015-01-20). 2730:Open Access Emergency Medicine 1848:in Burbank, at the age of 69. 1125:transesophageal echocardiogram 876:transesophageal echocardiogram 854: 566:left ventricular outflow tract 391:, and type B, which does not. 1: 5267:Deaths from aortic dissection 4607:Aneurysm of sinus of Valsalva 4461:Monckeberg's arteriosclerosis 4079:Dugan C (December 21, 2016). 4007:Petersen C (April 27, 1989). 3465:10.1016/S0003-4975(10)65594-4 3424:10.1016/S0022-5223(19)33323-9 3185:10.1016/j.amjcard.2010.12.027 2724:Karkhanis V, Joshi J (2012). 2692:"Acute Myocardial Infarction" 2485:10.1053/j.semtcvs.2016.10.002 2402:Cassoobhoy A (30 June 2020). 2146:Texas Heart Institute Journal 2020:10.1016/s0140-6736(14)61005-9 1784:, best known for the musical 934:on radiograph is of moderate 820:(10%), or just distal to the 506:occurs about 3% of the time. 4912:Chronic venous insufficiency 4537:Aortoiliac occlusive disease 3212:Annals of Emergency Medicine 3043:"Abdominal Aortic Aneurysms" 2991:10.1161/CIR.0b013e3181d4739e 2090:10.1097/tme.0b013e31827145d0 1877:In August 2021, New Zealand 436:caused by bleeding into the 65:descending part of the aorta 4927:Inferior vena cava syndrome 4922:Superior vena cava syndrome 4649:Vertebral artery dissection 4639:Intracranial berry aneurysm 4243:Blabbermouth (2021-10-11). 4109:"Actor Alan Thicke, dad on 3533:10.1016/j.ijcha.2015.01.009 3296:Emergency Medicine Practice 3136:Academic Emergency Medicine 2860:10.1007/978-94-007-7893-1_6 2588:Rahimi A, Geiger Z (2021). 2190:JRSM Cardiovascular Disease 1943:Vertebral artery dissection 884:higher-frequency ultrasound 671:Connective tissue disorders 67:(3), which starts from the 5303: 5028:Hypertensive heart disease 4679:Arteriovenous malformation 4654:Familial aortic dissection 3736:10.1016/j.cjca.2015.09.003 3617:Emerg. Med. Clin. North Am 2289:John Elefteriades (2007). 1746:Baylor College of Medicine 1241: 1064:Magnetic resonance imaging 905:American Heart Association 702:dissections of the aorta. 542:(supplying the left arm). 524:cystic medial degeneration 504:ischemia of the intestines 325:connective tissue diseases 31: 5053:Renovascular hypertension 4996:Hepatic artery thrombosis 4644:Carotid artery dissection 4597:Abdominal aortic aneurysm 4447:Intermittent claudication 4410:Peripheral artery disease 4162:hermesauto (2020-09-19). 3701:. John Wiley & Sons. 3629:10.1016/j.emc.2009.07.007 3261:10.1007/s00059-012-3710-1 2946:10.1016/j.ccc.2007.07.002 2829:10.1016/j.tcm.2014.12.013 2794:10.1016/j.emc.2017.07.003 2525:10.1016/j.ccl.2017.03.007 2442:10.1007/s00595-015-1193-4 2295:. CRC Press. p. 31. 2203:10.1177/20480040211047122 1938:Carotid artery dissection 1920:In May 2022, keyboardist 1324: 826:descending thoracic aorta 725:intra-aortic balloon pump 438:sac surrounding the heart 62: 53: 34:Abdominal aortic aneurysm 5038:Hypertensive nephropathy 4851:Post-thrombotic syndrome 4832:Paget–Schroetter disease 4624:Coronary artery aneurysm 4602:Thoracic aortic aneurysm 3854:Altman LK (2006-12-25). 3805:Leonard JC (July 1979). 3410:J Thorac Cardiovasc Surg 3391:Demers & Miller 2016 3076:Johns Hopkins University 2335:10.1161/01.CIR.90.5.2375 1899:of the heavy metal band 1888:. He was transferred to 1529:) when no damage to the 1484:Calcium channel blockers 1194:Type A aortic dissection 1176:Type A aortic dissection 1049:of an aortic dissection 657:congenital heart disease 461:congestive heart failure 365:inflammation of arteries 361:thoracic aortic aneurysm 286:forcing the layers apart 32:Not to be confused with 5093:Orthostatic hypotension 5075:White coat hypertension 4552:Fibromuscular dysplasia 4516:Carotid artery stenosis 3982:Flint PB (1989-04-27). 3302:(12): 1–23, quiz 23-4. 3290:Lo BM (December 2013). 2363:"Acute aortic syndrome" 1797:On September 11, 2003, 1574:coronary artery disease 1556:vascular ring connector 898:A measurement of blood 721:cardiac catheterization 401:inside the blood vessel 389:first part of the aorta 5065:Pulmonary hypertension 5048:Secondary hypertension 5043:Essential hypertension 5033:Hypertensive emergency 4874:Portacaval anastomosis 4810:Portal vein thrombosis 4452:Critical limb ischemia 4353:Cardiovascular disease 4035:Woo E (May 28, 2004). 3823:10.1136/bmj.2.6184.260 3775:10.1098/rstl.1761.0052 3366:Ultrasound of the Week 3333:Ultrasound of the Week 3019:Dual Source CT Imaging 2658:"Aortic Insufficiency" 2624:"Aortic Insufficiency" 1895:41-year-old guitarist 1858:Taiwanese entertainer 1617: 1448:mean arterial pressure 1325:Stanford A (proximal) 1060: 924: 844:cystic medial necrosis 801: 757: 679:Ehlers–Danlos syndrome 611:and the chest wall or 540:left subclavian artery 536:brachiocephalic artery 534:to involvement of the 493:central nervous system 333:Ehlers–Danlos syndrome 266: 238:3 per 100,000 per year 98:cardiothoracic surgery 69:left subclavian artery 5262:Diseases of the aorta 5070:Systolic hypertension 4815:Renal vein thrombosis 4674:Arteriovenous fistula 4666:Vascular malformation 4634:Intracranial aneurysm 4521:Renal artery stenosis 3335:. 12 September 2014. 1730:Thomas Bevill Peacock 1615: 1045: 918: 822:ligamentum arteriosum 798: 755: 653:bicuspid aortic valve 576:Myocardial infarction 473:peripheral neuropathy 442:pericardial tamponade 369:abnormal lipid levels 337:bicuspid aortic valve 264: 179:bicuspid aortic valve 5287:IgG4-related disease 4984:Paradoxical embolism 4979:Cholesterol embolism 4805:May–Thurner syndrome 4800:Budd–Chiari syndrome 4783:Deep vein thrombosis 4778:primarily lower limb 4557:Raynaud's phenomenon 4232:– via YouTube. 3099:Anderson BE (2012). 2903:(5 Suppl): S127–28. 2292:Acute Aortic Disease 1474:sodium nitroprusside 1328:Stanford B (distal) 1109:displaying the true 979:) may be warranted. 977:transesophageal echo 736:aortic insufficiency 695:polyarteritis nodosa 691:giant cell arteritis 687:Takayasu's arteritis 683:Loeys–Dietz syndrome 619:Predisposing factors 551:Aortic insufficiency 546:Aortic insufficiency 397:opening in the chest 314:rupture of the aorta 171:Loeys-Dietz Syndrome 5277:Medical emergencies 5060:Benign hypertension 3757:Nicholls F (1761). 3585:"Aortic Dissection" 3491:"Aortic Dissection" 2743:10.2147/OAEM.S29942 2404:"Aortic Dissection" 1886:Canberra, Australia 1801:was diagnosed with 1752:Well-known patients 1641: 1523:Open aortic surgery 1266: 983:Computed tomography 516:high blood pressure 321:high blood pressure 306:mesenteric ischemia 220:Depends on the type 163:High blood pressure 139:myocardial ischemia 135:mesenteric ischemia 71:and extends to the 5193:External resources 4974:Pulmonary embolism 4884:Esophageal varices 4822:upper limb / torso 4466:Arteriolosclerosis 4068:. 3 February 2014. 3988:The New York Times 3861:The New York Times 3149:10.1111/acem.13360 2940:(4): 779–800, vi. 2513:Cardiology Clinics 2140:Criado FJ (2011). 1738:Michael E. DeBakey 1664:in first 72 hours 1656:in first 24 hours 1639: 1618: 1450:(MAP) of 60 to 75 1345:Michael E. DeBakey 1264: 1061: 925: 882:allows the use of 802: 758: 568:, causing intimal 528:low blood pressure 419:Signs and symptoms 413:Michael E. DeBakey 290:chest or back pain 267: 111:chest or back pain 18:Aortic dissections 5249: 5248: 5229:Aortic dissection 5105: 5104: 5101: 5100: 4945:Arteries or veins 4940: 4939: 4765:Venous thrombosis 4732: 4731: 4714:Cherry hemangioma 4614:Aortic dissection 4565: 4564: 4400:Buerger's disease 4309:978-0-323-24126-7 4168:The Straits Times 4144:. 4 February 2018 4115:. San Francisco: 4041:Los Angeles Times 3900:on 5 January 2016 3708:978-1-4051-8039-9 3662:(24): 2611–2618. 3623:(4): 685–712, x. 3452:Ann. Thorac. Surg 3368:. 8 August 2015. 3049:. 16 October 2020 3028:978-3-540-77601-7 2869:978-94-007-7892-4 2569:978-0-323-29544-4 2373:(10): 1122–1127. 2302:978-1-4200-1976-6 2275:978-1-4557-4987-4 2248:978-1-4377-2770-8 2014:(9970): 800–811. 1851:Japanese actress 1814:Days of Our Lives 1803:aortic dissection 1684: 1683: 1592:obstructive shock 1583:Cardiac tamponade 1537:Bentall procedure 1370:and hypertension. 1332: 1331: 1227: 1208: 1189: 1171: 1153: 953:Pleural effusions 928:Chest radiography 778:basement membrane 774:endothelial cells 629:connective tissue 593:cardiac tamponade 585:coronary arteries 270:Aortic dissection 262: 242: 241: 198:Diagnostic method 49:Aortic dissection 43:Medical condition 16:(Redirected from 5294: 5282:Vascular surgery 5109: 5016: 4827:Mondor's disease 4770:Thrombophlebitis 4743: 4419:Arteriosclerosis 4415: 4376: 4346: 4339: 4332: 4323: 4313: 4285: 4284: 4282: 4281: 4265: 4259: 4258: 4256: 4255: 4240: 4234: 4233: 4231: 4230: 4214: 4208: 4207: 4201: 4200: 4184: 4178: 4177: 4175: 4174: 4159: 4153: 4152: 4150: 4149: 4134: 4128: 4127: 4125: 4123: 4104: 4098: 4097: 4095: 4093: 4076: 4070: 4069: 4058: 4052: 4051: 4049: 4047: 4032: 4026: 4025: 4023: 4021: 4004: 3998: 3997: 3995: 3994: 3979: 3973: 3972: 3970: 3968: 3949: 3943: 3942: 3940: 3938: 3919: 3910: 3909: 3907: 3905: 3896:. Archived from 3886: 3877: 3876: 3874: 3873: 3851: 3845: 3844: 3834: 3817:(6184): 260–62. 3802: 3791: 3790: 3754: 3748: 3747: 3719: 3713: 3712: 3692: 3686: 3685: 3671: 3647: 3641: 3640: 3612: 3606: 3605: 3604: 3603: 3580: 3563: 3562: 3552: 3512: 3506: 3505: 3503: 3501: 3487: 3478: 3477: 3467: 3443: 3437: 3436: 3426: 3400: 3394: 3388: 3382: 3381: 3379: 3377: 3358: 3349: 3348: 3346: 3344: 3325: 3316: 3315: 3287: 3281: 3280: 3244: 3238: 3237: 3227: 3203: 3197: 3196: 3168: 3162: 3161: 3151: 3127: 3121: 3120: 3096: 3087: 3086: 3084: 3082: 3068: 3059: 3058: 3056: 3054: 3039: 3033: 3032: 3014: 3008: 3007: 2993: 2984:(13): e266–369. 2969: 2958: 2957: 2929: 2923: 2922: 2912: 2888: 2882: 2881: 2847: 2841: 2840: 2812: 2806: 2805: 2777: 2766: 2765: 2755: 2745: 2721: 2715: 2714: 2712: 2710: 2687: 2681: 2680: 2678: 2676: 2653: 2647: 2646: 2644: 2642: 2619: 2613: 2612: 2610: 2608: 2585: 2579: 2578: 2577: 2576: 2543: 2537: 2536: 2508: 2497: 2496: 2468: 2462: 2461: 2425: 2419: 2418: 2416: 2414: 2399: 2393: 2392: 2382: 2358: 2352: 2351: 2337: 2328:(5): 2375–2378. 2313: 2307: 2306: 2286: 2280: 2279: 2259: 2253: 2252: 2232: 2226: 2225: 2215: 2205: 2181: 2172: 2171: 2161: 2137: 2102: 2101: 2071: 2040: 2039: 2003: 1916: 1915: 1911: 1908: 1642: 1579:Aneurysm leakage 1290: 1283: 1276: 1267: 1229: 1228: 1210: 1209: 1191: 1190: 1173: 1172: 1155: 1154: 1099: 1090: 1029: 1017: 1005: 699:Behçet's disease 605:pleural effusion 599:Pleural effusion 263: 94:Vascular surgery 58: 46: 21: 5302: 5301: 5297: 5296: 5295: 5293: 5292: 5291: 5272:Causes of death 5252: 5251: 5250: 5245: 5244: 5188: 5187: 5120: 5106: 5097: 5079: 5005: 4962:Microangiopathy 4957:Macroangiopathy 4936: 4900: 4869:Gastric varices 4855: 4768: 4759: 4728: 4700: 4660: 4592:Aortic aneurysm 4578: 4561: 4547:Erythromelalgia 4525: 4502: 4427:Atherosclerosis 4404: 4368: 4356: 4350: 4320: 4310: 4297: 4294: 4289: 4288: 4279: 4277: 4267: 4266: 4262: 4253: 4251: 4242: 4241: 4237: 4228: 4226: 4216: 4215: 4211: 4198: 4196: 4186: 4185: 4181: 4172: 4170: 4161: 4160: 4156: 4147: 4145: 4136: 4135: 4131: 4121: 4119: 4106: 4105: 4101: 4091: 4089: 4078: 4077: 4073: 4060: 4059: 4055: 4045: 4043: 4034: 4033: 4029: 4019: 4017: 4014:Chicago Tribune 4006: 4005: 4001: 3992: 3990: 3981: 3980: 3976: 3966: 3964: 3951: 3950: 3946: 3936: 3934: 3921: 3920: 3913: 3903: 3901: 3888: 3887: 3880: 3871: 3869: 3853: 3852: 3848: 3804: 3803: 3794: 3756: 3755: 3751: 3721: 3720: 3716: 3709: 3694: 3693: 3689: 3649: 3648: 3644: 3614: 3613: 3609: 3601: 3599: 3582: 3581: 3566: 3514: 3513: 3509: 3499: 3497: 3489: 3488: 3481: 3445: 3444: 3440: 3402: 3401: 3397: 3393:, p. 1216. 3389: 3385: 3375: 3373: 3360: 3359: 3352: 3342: 3340: 3327: 3326: 3319: 3289: 3288: 3284: 3246: 3245: 3241: 3205: 3204: 3200: 3170: 3169: 3165: 3129: 3128: 3124: 3113: 3098: 3097: 3090: 3080: 3078: 3070: 3069: 3062: 3052: 3050: 3041: 3040: 3036: 3029: 3016: 3015: 3011: 2971: 2970: 2961: 2931: 2930: 2926: 2890: 2889: 2885: 2870: 2849: 2848: 2844: 2814: 2813: 2809: 2779: 2778: 2769: 2723: 2722: 2718: 2708: 2706: 2689: 2688: 2684: 2674: 2672: 2655: 2654: 2650: 2640: 2638: 2621: 2620: 2616: 2606: 2604: 2587: 2586: 2582: 2574: 2572: 2570: 2545: 2544: 2540: 2510: 2509: 2500: 2470: 2469: 2465: 2427: 2426: 2422: 2412: 2410: 2401: 2400: 2396: 2360: 2359: 2355: 2315: 2314: 2310: 2303: 2288: 2287: 2283: 2276: 2261: 2260: 2256: 2249: 2234: 2233: 2229: 2183: 2182: 2175: 2139: 2138: 2105: 2073: 2072: 2043: 2005: 2004: 1961: 1956: 1934: 1913: 1909: 1906: 1904: 1897:Richie Faulkner 1792:Marfan Syndrome 1782:Jonathan Larson 1759:Three's Company 1754: 1710: 1693: 1680:in first month 1637: 1622:aortic aneurysm 1610: 1543:David procedure 1508: 1436: 1423: 1407: 1377: 1368:atherosclerosis 1341: 1262: 1246: 1240: 1233: 1230: 1219: 1214: 1211: 1200: 1195: 1192: 1182: 1177: 1174: 1164: 1159: 1156: 1145: 1121: 1120: 1119: 1118: 1102: 1101: 1100: 1092: 1091: 1080: 1059: 1040: 1033: 1030: 1021: 1018: 1009: 1006: 985: 913: 896: 863: 814:ascending aorta 750: 748:Pathophysiology 706:Turner syndrome 675:Marfan syndrome 646:methamphetamine 621: 601: 578: 570:intussusception 548: 512: 471:(6%), ischemic 421: 373:medical imaging 339:; and previous 329:Marfan syndrome 298:lightheadedness 278:innermost layer 244: 203:Medical imaging 175:Turner syndrome 167:Marfan syndrome 119:lightheadedness 77:ascending aorta 73:abdominal aorta 44: 41: 28: 23: 22: 15: 12: 11: 5: 5300: 5298: 5290: 5289: 5284: 5279: 5274: 5269: 5264: 5254: 5253: 5247: 5246: 5243: 5242: 5231: 5220: 5209: 5197: 5196: 5194: 5190: 5189: 5186: 5185: 5174: 5163: 5152: 5137: 5121: 5116: 5115: 5113: 5112:Classification 5103: 5102: 5099: 5098: 5096: 5095: 5089: 5087: 5081: 5080: 5078: 5077: 5072: 5067: 5062: 5057: 5056: 5055: 5045: 5040: 5035: 5030: 5024: 5022: 5013: 5011:Blood pressure 5007: 5006: 5004: 5003: 4998: 4993: 4988: 4987: 4986: 4981: 4976: 4966: 4965: 4964: 4959: 4948: 4946: 4942: 4941: 4938: 4937: 4935: 4934: 4929: 4924: 4919: 4914: 4908: 4906: 4902: 4901: 4899: 4898: 4893: 4892: 4891: 4886: 4881: 4871: 4865: 4863: 4861:Varicose veins 4857: 4856: 4854: 4853: 4848: 4847: 4846: 4836: 4835: 4834: 4829: 4819: 4818: 4817: 4812: 4807: 4802: 4797: 4787: 4786: 4785: 4774: 4772: 4761: 4760: 4758: 4757: 4751: 4749: 4740: 4734: 4733: 4730: 4729: 4727: 4726: 4724:Spider angioma 4721: 4716: 4710: 4708: 4706:Vascular nevus 4702: 4701: 4699: 4698: 4697: 4696: 4691: 4684:Telangiectasia 4681: 4676: 4670: 4668: 4662: 4661: 4659: 4658: 4657: 4656: 4651: 4646: 4641: 4636: 4626: 4621: 4619:Aortic rupture 4616: 4611: 4610: 4609: 4604: 4599: 4584: 4582: 4580:pseudoaneurysm 4567: 4566: 4563: 4562: 4560: 4559: 4554: 4549: 4544: 4539: 4533: 4531: 4527: 4526: 4524: 4523: 4518: 4512: 4510: 4504: 4503: 4501: 4500: 4499: 4498: 4493: 4491:Oxycholesterol 4488: 4483: 4478: 4473: 4463: 4457: 4456: 4455: 4454: 4449: 4444: 4439: 4434: 4423: 4421: 4412: 4406: 4405: 4403: 4402: 4397: 4396: 4395: 4384: 4382: 4373: 4358: 4357: 4351: 4349: 4348: 4341: 4334: 4326: 4319: 4318:External links 4316: 4315: 4314: 4308: 4293: 4290: 4287: 4286: 4260: 4235: 4209: 4179: 4154: 4129: 4099: 4071: 4053: 4027: 3999: 3974: 3953:"Ritter Rules" 3944: 3911: 3890:"Ritter Rules" 3878: 3846: 3792: 3749: 3714: 3707: 3687: 3642: 3607: 3564: 3507: 3479: 3438: 3395: 3383: 3350: 3317: 3282: 3255:(3): 269–276. 3239: 3218:(4): 368–378. 3198: 3179:(8): 1227–34. 3163: 3142:(4): 397–412. 3122: 3112:978-1455726646 3111: 3088: 3060: 3034: 3027: 3009: 2959: 2934:Crit Care Clin 2924: 2897:Fertil. Steril 2883: 2868: 2842: 2823:(6): 517–526. 2807: 2788:(4): 847–867. 2767: 2716: 2682: 2648: 2614: 2580: 2568: 2538: 2519:(3): 387–410. 2498: 2479:(2): 173–178. 2463: 2436:(5): 509–516. 2420: 2394: 2353: 2308: 2301: 2281: 2274: 2254: 2247: 2227: 2173: 2152:(6): 694–700. 2103: 2041: 1958: 1957: 1955: 1952: 1951: 1950: 1945: 1940: 1933: 1930: 1753: 1750: 1714:Frank Nicholls 1709: 1706: 1692: 1689: 1682: 1681: 1678: 1674: 1673: 1670: 1666: 1665: 1662: 1658: 1657: 1654: 1650: 1649: 1646: 1636: 1633: 1609: 1606: 1605: 1604: 1601:kidney failure 1597: 1594: 1585: 1580: 1577: 1570: 1567: 1560: 1559: 1552: 1546: 1540: 1534: 1507: 1504: 1444:left ventricle 1435: 1432: 1422: 1419: 1406: 1403: 1394: 1393: 1387: 1376: 1373: 1372: 1371: 1361: 1355: 1340: 1337: 1330: 1329: 1326: 1323: 1320: 1319: 1316: 1313: 1310: 1306: 1305: 1302: 1299: 1296: 1292: 1291: 1284: 1277: 1270: 1261: 1260:Classification 1258: 1242:Main article: 1239: 1236: 1235: 1234: 1231: 1217: 1215: 1212: 1198: 1196: 1193: 1180: 1178: 1175: 1162: 1160: 1157: 1143: 1107:echocardiogram 1104: 1103: 1094: 1093: 1085: 1084: 1083: 1082: 1081: 1079: 1076: 1072:claustrophobia 1058: 1057: 1054: 1050: 1039: 1036: 1035: 1034: 1031: 1024: 1022: 1019: 1012: 1010: 1007: 1000: 993:bolus tracking 984: 981: 973:MR angiography 964: 963: 956: 950: 912: 909: 895: 892: 862: 859: 749: 746: 667:of the valve. 659:involving the 620: 617: 600: 597: 577: 574: 547: 544: 511: 510:Blood pressure 508: 500:renal arteries 481:cardiac arrest 420: 417: 323:; a number of 240: 239: 236: 232: 231: 228: 222: 221: 218: 214: 213: 210: 206: 205: 200: 194: 193: 160: 154: 153: 150: 146: 145: 143:aortic rupture 128: 122: 121: 107: 101: 100: 91: 85: 84: 60: 59: 51: 50: 42: 38:Aortic rupture 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 5299: 5288: 5285: 5283: 5280: 5278: 5275: 5273: 5270: 5268: 5265: 5263: 5260: 5259: 5257: 5241: 5237: 5236: 5232: 5230: 5226: 5225: 5221: 5219: 5215: 5214: 5210: 5208: 5204: 5203: 5199: 5198: 5195: 5191: 5184: 5180: 5179: 5175: 5173: 5169: 5168: 5164: 5162: 5158: 5157: 5153: 5151: 5147: 5146: 5142: 5138: 5136: 5132: 5131: 5127: 5123: 5122: 5119: 5114: 5110: 5094: 5091: 5090: 5088: 5086: 5082: 5076: 5073: 5071: 5068: 5066: 5063: 5061: 5058: 5054: 5051: 5050: 5049: 5046: 5044: 5041: 5039: 5036: 5034: 5031: 5029: 5026: 5025: 5023: 5021: 5017: 5014: 5012: 5008: 5002: 4999: 4997: 4994: 4992: 4989: 4985: 4982: 4980: 4977: 4975: 4972: 4971: 4970: 4967: 4963: 4960: 4958: 4955: 4954: 4953: 4950: 4949: 4947: 4943: 4933: 4930: 4928: 4925: 4923: 4920: 4918: 4915: 4913: 4910: 4909: 4907: 4903: 4897: 4894: 4890: 4887: 4885: 4882: 4880: 4879:Caput medusae 4877: 4876: 4875: 4872: 4870: 4867: 4866: 4864: 4862: 4858: 4852: 4849: 4845: 4842: 4841: 4840: 4837: 4833: 4830: 4828: 4825: 4824: 4823: 4820: 4816: 4813: 4811: 4808: 4806: 4803: 4801: 4798: 4796: 4793: 4792: 4791: 4788: 4784: 4781: 4780: 4779: 4776: 4775: 4773: 4771: 4766: 4762: 4756: 4753: 4752: 4750: 4748: 4744: 4741: 4739: 4735: 4725: 4722: 4720: 4717: 4715: 4712: 4711: 4709: 4707: 4703: 4695: 4692: 4690: 4687: 4686: 4685: 4682: 4680: 4677: 4675: 4672: 4671: 4669: 4667: 4663: 4655: 4652: 4650: 4647: 4645: 4642: 4640: 4637: 4635: 4632: 4631: 4630: 4627: 4625: 4622: 4620: 4617: 4615: 4612: 4608: 4605: 4603: 4600: 4598: 4595: 4594: 4593: 4589: 4586: 4585: 4583: 4581: 4576: 4572: 4568: 4558: 4555: 4553: 4550: 4548: 4545: 4543: 4542:Degos disease 4540: 4538: 4535: 4534: 4532: 4528: 4522: 4519: 4517: 4514: 4513: 4511: 4509: 4505: 4497: 4494: 4492: 4489: 4487: 4484: 4482: 4479: 4477: 4474: 4472: 4469: 4468: 4467: 4464: 4462: 4459: 4458: 4453: 4450: 4448: 4445: 4443: 4440: 4438: 4435: 4433: 4430: 4429: 4428: 4425: 4424: 4422: 4420: 4416: 4413: 4411: 4407: 4401: 4398: 4394: 4391: 4390: 4389: 4386: 4385: 4383: 4381: 4377: 4374: 4372: 4367: 4363: 4359: 4354: 4347: 4342: 4340: 4335: 4333: 4328: 4327: 4324: 4317: 4311: 4305: 4301: 4296: 4295: 4291: 4275: 4271: 4264: 4261: 4250: 4246: 4239: 4236: 4225: 4221: 4220: 4213: 4210: 4205: 4194: 4190: 4183: 4180: 4169: 4165: 4158: 4155: 4143: 4139: 4133: 4130: 4118: 4114: 4113:, dead at 69" 4112: 4111:Growing Pains 4103: 4100: 4088: 4087: 4082: 4075: 4072: 4067: 4063: 4057: 4054: 4042: 4038: 4031: 4028: 4016: 4015: 4010: 4003: 4000: 3989: 3985: 3978: 3975: 3962: 3958: 3954: 3948: 3945: 3932: 3928: 3924: 3918: 3916: 3912: 3899: 3895: 3891: 3885: 3883: 3879: 3867: 3863: 3862: 3857: 3850: 3847: 3842: 3838: 3833: 3828: 3824: 3820: 3816: 3812: 3808: 3801: 3799: 3797: 3793: 3788: 3784: 3780: 3776: 3772: 3768: 3764: 3760: 3753: 3750: 3745: 3741: 3737: 3733: 3729: 3725: 3718: 3715: 3710: 3704: 3700: 3699: 3691: 3688: 3683: 3679: 3675: 3670: 3665: 3661: 3657: 3653: 3646: 3643: 3638: 3634: 3630: 3626: 3622: 3618: 3611: 3608: 3598: 3594: 3590: 3586: 3579: 3577: 3575: 3573: 3571: 3569: 3565: 3560: 3556: 3551: 3546: 3542: 3538: 3534: 3530: 3526: 3522: 3518: 3511: 3508: 3496: 3492: 3486: 3484: 3480: 3475: 3471: 3466: 3461: 3458:(3): 237–47. 3457: 3453: 3449: 3442: 3439: 3434: 3430: 3425: 3420: 3416: 3412: 3411: 3406: 3399: 3396: 3392: 3387: 3384: 3371: 3367: 3363: 3357: 3355: 3351: 3338: 3334: 3330: 3324: 3322: 3318: 3313: 3309: 3305: 3301: 3297: 3293: 3286: 3283: 3278: 3274: 3270: 3266: 3262: 3258: 3254: 3250: 3243: 3240: 3235: 3231: 3226: 3221: 3217: 3213: 3209: 3202: 3199: 3194: 3190: 3186: 3182: 3178: 3174: 3167: 3164: 3159: 3155: 3150: 3145: 3141: 3137: 3133: 3126: 3123: 3118: 3114: 3108: 3104: 3103: 3095: 3093: 3089: 3077: 3073: 3067: 3065: 3061: 3048: 3044: 3038: 3035: 3030: 3024: 3020: 3013: 3010: 3005: 3001: 2997: 2992: 2987: 2983: 2979: 2975: 2968: 2966: 2964: 2960: 2955: 2951: 2947: 2943: 2939: 2935: 2928: 2925: 2920: 2916: 2911: 2906: 2902: 2898: 2894: 2887: 2884: 2879: 2875: 2871: 2865: 2861: 2857: 2853: 2846: 2843: 2838: 2834: 2830: 2826: 2822: 2818: 2811: 2808: 2803: 2799: 2795: 2791: 2787: 2783: 2776: 2774: 2772: 2768: 2763: 2759: 2754: 2749: 2744: 2739: 2735: 2731: 2727: 2720: 2717: 2705: 2701: 2697: 2693: 2686: 2683: 2671: 2667: 2663: 2659: 2652: 2649: 2637: 2633: 2629: 2625: 2618: 2615: 2603: 2599: 2595: 2591: 2584: 2581: 2571: 2565: 2561: 2557: 2553: 2549: 2542: 2539: 2534: 2530: 2526: 2522: 2518: 2514: 2507: 2505: 2503: 2499: 2494: 2490: 2486: 2482: 2478: 2474: 2467: 2464: 2459: 2455: 2451: 2447: 2443: 2439: 2435: 2431: 2430:Surgery Today 2424: 2421: 2409: 2405: 2398: 2395: 2390: 2386: 2381: 2376: 2372: 2368: 2364: 2357: 2354: 2349: 2345: 2341: 2336: 2331: 2327: 2323: 2319: 2312: 2309: 2304: 2298: 2294: 2293: 2285: 2282: 2277: 2271: 2267: 2266: 2258: 2255: 2250: 2244: 2240: 2239: 2231: 2228: 2223: 2219: 2214: 2209: 2204: 2199: 2195: 2191: 2187: 2180: 2178: 2174: 2169: 2165: 2160: 2155: 2151: 2147: 2143: 2136: 2134: 2132: 2130: 2128: 2126: 2124: 2122: 2120: 2118: 2116: 2114: 2112: 2110: 2108: 2104: 2099: 2095: 2091: 2087: 2083: 2079: 2078: 2070: 2068: 2066: 2064: 2062: 2060: 2058: 2056: 2054: 2052: 2050: 2048: 2046: 2042: 2037: 2033: 2029: 2025: 2021: 2017: 2013: 2009: 2002: 2000: 1998: 1996: 1994: 1992: 1990: 1988: 1986: 1984: 1982: 1980: 1978: 1976: 1974: 1972: 1970: 1968: 1966: 1964: 1960: 1953: 1949: 1946: 1944: 1941: 1939: 1936: 1935: 1931: 1929: 1927: 1923: 1922:Andy Fletcher 1918: 1902: 1898: 1893: 1891: 1887: 1883: 1880: 1875: 1873: 1872: 1867: 1866:Kentaro Miura 1863: 1861: 1856: 1854: 1849: 1847: 1843: 1839: 1836: 1832: 1828: 1826: 1825:Richard Biggs 1822: 1821: 1816: 1815: 1810: 1808: 1804: 1800: 1795: 1793: 1789: 1788: 1783: 1778: 1775: 1771: 1769: 1765: 1761: 1760: 1751: 1749: 1747: 1743: 1742:Denton Cooley 1739: 1734: 1731: 1727: 1723: 1719: 1715: 1707: 1705: 1703: 1699: 1690: 1688: 1679: 1676: 1675: 1672:in two weeks 1671: 1668: 1667: 1663: 1660: 1659: 1655: 1652: 1651: 1647: 1644: 1643: 1634: 1632: 1629: 1625: 1623: 1614: 1607: 1602: 1598: 1595: 1593: 1589: 1586: 1584: 1581: 1578: 1575: 1571: 1568: 1565: 1564: 1563: 1557: 1553: 1550: 1547: 1544: 1541: 1538: 1535: 1532: 1528: 1524: 1521: 1520: 1519: 1516: 1512: 1505: 1503: 1499: 1497: 1493: 1489: 1485: 1481: 1479: 1475: 1471: 1467: 1463: 1459: 1458:Beta blockers 1455: 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