Management of Acute Aortic Dissections

cute dissecting aneurysm of the aorta continues to ,be associated with an excessively high mortality.Consequently, both surgical A and nonsurgical therapeutic approaches have evolved.T h e superiority of one method over the other has not been clearly demonstrated.At most institutions the tendency has been to use one method to the exclusion of the other.In reviewing the literature [13, 14, 16-18] and the experience at Stanford University Hospital, it has become apparent that there is a very significant and distinct difference in the clinical course and prognosis in patients in whom the ascending aorta is involved with dissection as opposed to those in whom disease does not extend proximal to the left subclavian artery.Aortography makes it possible in nearly all cases to determine the site of the initial intimal tear [12, 221 or at least to determine if the ascending aorta is involved.A therapeutic approach has evolved which utilizes both surgical and medical methods of management, depending upon the origin of the dissection.The present report describes this method of management and relates the experience at the Stanford University Hospital.