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Interventional radiology key to treatment of acute aortic syndrome, many points to be demonstrated at ECR 2010 congress on March March 4 - 8, 2010 in Austria Center, Vienna.

Many factors can lead to acute aortic syndrome, a life threatening disease in which patients present with symptoms mimicking myocardial infarction. Imaging modalities help to determine what may be causing pain in the chest. However, diagnosis is not the only benefit that imaging offers when it comes to the aorta. Interventional radiology has an increasing role in the treatment of thoracic aortic rupture and certain aortic dissections. It is also a powerful tool in the follow‐up of endovascular procedures. These points will be demonstrated in a dedicated session at ECR 10 .

Aortic dissection is the most serious disease of the aorta. It is also quite common, and may be caused by trauma, genetic pathologies, diseases of the elastic tissue such as Marfan disease, or atheroma, a swelling in artery walls. Experts distinguish two types of dissection: type A, located at the aorta root, and type B, located near the left subclavian artery. Whereas surgery is most commonly used to fix type A dissections, drugs have long been regarded as the main method for treating type B dissections. Only recently have endovascular stent grafts become the standard of care for complicated, acute type B dissection.

By placing an endograft in the descending aorta to close the tear in the artery wall, radiologists promote the thrombosis of the false lumen. Over the years, endovascular techniques have been refined and several are now offered to treat complicated type B dissections. Percutaneous fenestration involves creating another wide orifice between the false and true lumens in order to reduce pressure in the false lumen. Prostheses can also be placed in branches, or digestive or renal arteries.

Endovascular management has proved a lot more efficient than surgery, not only in type B dissection but also in thoracic aortic rupture, a catastrophic event that is usually caused by car accidents and leads to rapid death in many cases. For patients who survive the initial injury and make it to the hospital, endovascular procedures offer a better chance of survival than surgery.

Patients who undergo endovascular treatment for acute aortic syndrome require suitable imaging followup to check the continuing beneficial effects of therapy and the integrity of the devices. This starts before discharge from hospital and usually involves annual CT scans and plain radiography .

Source: ECR

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