Complications-acute aortic syndromes

(occur in ~20%; Circ 2010;121:e266; Lancet 2015;385:800)

• Freq assess (sx, BP, UOP), pulses, labs (Cr, Hb, lactic acid), imaging (~7 d or sooner if ∆s)
• Uncontrolled BP or persistent pain may indicate complication/extension
• Progression: propagation of dissection, ↑ aneurysm size, ↑ false lumen size
• Rupture: pericardial sac → tamponade (avoid pericardiocentesis unless PEA); blood in pleural space, mediast., retroperitoneum; ↑ in hematoma on imaging portends rupture
• Malperfusion (partial or complete obstruction of branch artery; can be static or dynamic) coronary → MI (usually RCA → IMI b/c dissection follows outer Ao curvature); innominate/carotid → CVA, Horner; intercostal/lumbar → spinal cord ischemia/paraplegia; innominate/subclavian → upper ext ischemia; iliac → lower ext ischemia; celiac/mesenteric → bowel ischemia; renal → AKI or slow ↑ Cr, refractory HTN
• AI: due to annular dilatation or disruption or displacement of leaflet by false lumen
• Mortality: 20–40% for proximal; 6% for uncomplicated and ~20% for complicated distal
• Long-term serial imaging (CT or MRI; ↓ rad w/ MRI) at 1, 3, and 6 mo, and then annually