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Abstrakt
Aortic Hiatus and Treatment for Acute Aortic Dissections
Katsuhiko Oda
Treatment options did not exist for Acute Aortic Dissection (AAD) until the 1940s. de Bakey, et al. claimed that surgical procedures should be used for all types of AAD categorized according to the de Bakey classification (1965). However, since 1970, the Stanford classification has recommended that surgery should be used for type A, and medical treatment for type B. Currently, Thoracic Endovascular Aortic Repair (TEVAR) is a third option. There is still no consensus on these three treatment options for AAD treatment. Herein, I report a strategy of combining tear-oriented initial surgery and subsequent TEVAR for type A AAD, and its outcomes. I focused on the role of Aortic Hiatus (AH) in the outcome of AAD. Timely and precise TEVAR for closing of patent tears that cause False Lumen Expansion (FLE) above the AH may improve outcomes. This strategy may be useful in type A AAD treatment. I also present an overview of the history of AAD treatment and of the available strategies.