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By Mardi Gomberg-Maitland, Jonathan L. Halperin, Mark A. Creager (auth.), Mark A. Creager MD (eds.)

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All patients, whether treated initially with medical or surgical therapy, merit such careful follow-up. Imaging modalities frequently used to follow patients long-term Chest radiography Computed tomography Magnetic resonance imaging Transesophageal echocardiography FIGURE 2-49. Ten-year actuarial survival in 156 patients with aortic dissection who received in-hospital treatment, either medical or surgical as indicated clinically. Depicted are actuarial survival curves for all 156 patients with aortic dissection, those 105 patients who were discharged from the hospital, and the general population matched for age and sex.

Eagle KA, DeSanctis RW: Diseases of the aorta. In Heart Disease: A Textbook of Cardiovascular Medicine, edn 4. Edited by Braunwald E. Philadelphia: Saunders; 1992: 1528-1557. 18. : Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl I Med 1999,340:1546-1552. 19. Grubb BP, Sirio e, Zelis R: Intravenous labetalol in acute aortic dissection. lAMA 1987,258:78-79. 20. : Acute and chronic aortic dissections: determinants of long-term outcome for operative survivors.

When such medial hemorrhage occurs without intimal rupture, it produces a variant of aortic dissection called intramural hematoma (see Fig. 2-46). (Adapted from Eagle et al. ) Pcripartum pcri od of prcgnan y (1'X») Cardiac catheteriza tion (2°;',) Prior cardiac surgery (18%) FIGURE 2-3. Etiology of aortic dissection in 464 patients in the International Registry of Aortic Dissection. Other uncommon but important predisposing factors include cocaine abuse and blunt trauma. Any disease process or other condition that undermines the integrity of the aortic media (either its elastic or muscular component) may predispose to aortic dissection.

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