Diseases of the aorta in the critically ill.

OBJECTIVE: To review diseases of the aorta that commonly require management in the critical care unit. DATA SOURCES: Articles and published reviews on aortic dissection, traumatic aortic rupture and aortic aneurysm. SUMMARY OF REVIEW: The aorta is the largest arterial vessel of the body and disorders that can lead to rupture (e.g. aortic dissection, traumatic aortic rupture and aortic aneurysm) are life threatening. Aortic dissections are usually classified for surgical purposes as those that involve the ascending aorta (i.e. type A dissections) which are usually managed surgically and all other dissections (i.e. type B dissections) which are usually managed non surgically. Recently, endoluminal aortic stents have been used to manage type B dissections. Traumatic aortic rupture usually follows an antero-posterior thoracic injury with 60% occurring just distal to the origin of the left subclavian artery and 25% at the ascending aorta. Treatment consists of open surgical repair ensuring that the aortic cross clamp times are less than 30 minutes to reduce the development of ischaemic cord lesions. Aortic aneurysm commonly occurs in the abdominal aorta and is usually surgically resected if > 5 cm in diameter. Post-operative care is commonly undertaken in the intensive care unit to monitor haemodynamic, respiratory and fluid and electrolyte status to reduce the incidence of renal and respiratory failure. While angiography is often used to diagnose these disorders, transoesophageal echocardiography, helical computed tomography (CT) and magnetic resonance imaging are becoming more commonly used and in selected conditions are recommended as the investigations of choice.
CONCLUSIONS: Aortic dissection, aortic aneurysm and aortic trauma may lead to aortic rupture with exsanguination and management commonly requires surgical intervention and postoperative care in a critical care unit.