Longterm Complications And Followup

Although the dissection of the aorta is an acute event, long-term survivors of aortic dissection are also predisposed to late complications, by other factors, including the underlying chronic disease of the aortic wall media, systemic hypertension, advanced age, rate of growth and size of aorta, presence of patent false lumen, and the entire spectrum of Marfan's syndrome—even after a successful and appropriate medical or surgical management3-15. Regardless of the type of dissection (proximal vs. distal, acute vs. chronic) and treatment (surgical vs. medical), at 10 years 15-30% of patients require new surgery for threatening conditions, including aortic expansion leading to redissection and rupture, progressive aortic regurgitation requiring aortic valve replacement, organ malperfusion with the risk of dysfunction, and irreversible ischemia3,5,7,9,16-18. In particular, enlarging saccular aneurysms, reported to develop in as many as 14-29% of patients with distal dissections, are at high risk of rupture and require prompt surgical repair3. Because the risk of aortic lesions is substantial in the first few months after initial therapy, surveillance of the aorta should start during initial hospitalization, with more frequent early follow-up at 1, 3, 6, 9, and 12 months after discharge and annually thereafter, depending also on the size and rate of the increase of the aorta's diameter5,18.

Thus, all patients, regardless of the initial therapeutic strategy implemented (surgical and/or endovascular stent grafting and/or medical) merit extremely close follow-up visits by a specialized team, including (1) long-term medical therapy with beta blockers to lower blood pressure, wall stress, and dP/dt and (2) serial imaging to detect potential complications in early stages5,18,19.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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