Thrombosed type A acute aortic dissection (TA AAD) is a particular type of aortic dissection. The incidence of TA AAD is not uncommon disease, and it ranges from 3 to 33 % in overall cases of type A AAD . Recently, TA AAD has been detected more frequently by the aid of advanced imaging devices. The computed tomographic finding of this disease is a crescent-shaped false lumen without any entry sites and obvious blood flow in the false lumen. The pathogenesis of TA AAD remains unclear. Spontaneous rupture of the aortic vasa vasorum is one of the pathogenic mechanisms for so-called âaortic dissection without tearâ or âintramural hematoma (IMH)â, which was mainly proposed in the western countries. Another mechanism is the false lumen thrombosis rapidly after the intimal tear develops probably due to lack of re-entry. Recently, Park and associates showed that a large proportion of IMH had intimal tear at ascending aorta or arch, which is the same pathogenesis as classical aortic dissection. The classical type A AAD generally requires emergent graft replacement including entry resection to prevent catastrophic clinical events such as aortic rupture or organ ischemia. In contrast, the optimal strategy for TA AAD still remains debatable. One of the reasons is the significant international differences in the outcomes of TA AAD . In Asian countries, particularly in Japan and Korea, favorable results have been reported in the strategy of medical therapy alone for uncomplicated patients or medical therapy and timed surgical intervention for complicated patients. Kan and coworkers analysed a total of 328 cases in 12 studies of type A IMH, demonstrating that the early mortality rate was not statistically different between surgical treatment group and medical treatment group (10.1% vs14.4%, respectively, p=0.37) .There are some advantages in elective aortic operation. The weak dissected aortic wall may stiffen, resulting in easy handling of the graft anastomosis. Moreover, satisfactory postoperative course could be obtained because there are some spare time to evaluate the patientsâ physical conditions such as brain, heart, liver and kidney. Kitai et al.reported that there were no significant differences of the 30-day mortality rate between the patients with type A IMH treated by medical therapy and those by emergent surgery . OMICS Group International is an open access online publishing group which has 700+ peer-reviewed journals, organizes 3000+ International Scientific Conferences per year, have around 50,000+ editorial board members and 1000+ Scientific associations. Medical Journals provide a platform for outstanding research around the globe in the field of medicine. These scholarly journals aim to contribute to the progress and application of scientific discoveries, by providing free access to the research information. The published work reaches the general public and the scientific community immediately after publication, thus providing higher citation rates for the author. Medical Journals are supported by 5000 internationally renowned editorial board members and a high quality review board. Medical Journals use online Editorial Manager System for quick and high quality review process. Articles of Medical journals are subjected to peer reviewing and these are included in the standard indexing databases like ISI, Scopus, EBSCO, CAS, HINARI etc. All the articles published in Medical journals are permanently archived in respective peer reviewed journals thus providing unrestricted utilization and requisition of the scientific information.
Last date updated on July, 2014