Top Things to Know: Imaging & Surveillance of Chronic Aortic Dissection
Published: February 17, 2022
Prepared by Johanna A. Sharp, MSN RN, Science and Medicine Advisor
- This statement presents state-of-the-art imaging and measurement techniques, which can be assembled into a standardized reporting system for patients with chronic aortic dissection.
- Patients surviving an acute aortic dissection require continued life-long surveillance of their diseased aorta. Late complications, seen in chronic false lumen degeneration and aneurysm formation often require surgical, endovascular or hybrid interventions to treat or prevent aortic rupture.
- Imaging chronic aortic dissection plays a central role in clinical decisions. Accuracy of aortic diameter measurements and the documentation of diameter changes over time using different imaging equipment and modalities creates a range of challenges in these complex patients.
- Imaging plays a central role in the surveillance of patients with chronic aortic dissection. Monitoring the inevitable degeneration and aneurysmal dilatation of residual aortic false lumen is critical for medical decisions and timing of interventions.
- A rough approximation of the prevalence of chronic aortic dissection suggests 92,000 to 138,000 survivors of acute dissection in the United States. An accurate prevalence of patients living with chronic aortic dissection in the United States is unknown and difficult to ascertain making it an important gap in knowledge and limitation in the ability to estimate long-term quality of life and cost effectiveness of evolving treatments or prevention strategies.
- In patients with chronic aortic dissection, it is imperative that each imaging study is carefully compared to prior studies, even those done at other facilities. Ideally, all prior studies should be reviewed before making a therapeutic decision. However, at a minimum, the most recent prior study and the earliest (baseline) study should be compared to the current study.
- To address the complex needs of consistent imaging surveillance the manuscript suggests a dedicated Surveillance Program requiring protocols for standardizing the measurement process and storing and retrieving all studies to compare measurements for life-long surveillance.
- Chronic aortic dissection is an under-recognized cardiovascular disease and growing health-care burden, owing to the improved survival of patients with acute aortic dissection. Imaging and image processing will continue to play a pivotal role for surveillance and for clinical decision making in patients with chronic dissection.
- High resolution imaging data, combined with computer simulations, biomechanical modelling and machine learning contributes to answering many of the questions to ultimately improve the lives of patients with chronic aortic dissection.
- New insights into the pathophysiology, hemodynamics and mechanobiology of chronic aortic dissection are necessary to support the current paradigm shift from a time-honored watch-and-wait treatment strategy to an individualized selection of traditional and new surgical, endovascular or hybrid interventions in the future.
Citation
Fleischmann D, Afifi RO, Casanegra AI, Elefteriades JA, Gleason TG, Hanneman K, Roselli EE, Willemink MJ, Fischbein MP; on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Clinical Cardiology; and Council on Cardiovascular Surgery and Anesthesia. Imaging and surveillance of chronic aortic dissection: a scientific statement from the American Heart Association. Circ Cardiovasc Imaging. 2022;15:e000075. doi: 10.1161/HCI.0000000000000075