Dissection of the aorta.

Our approach to management, both initial and definitive, is summarized in Table 2. Patients with proximal dissection require surgical intervention after medical stabilization, unless prior debilitating illness precludes general anesthesia or prolonged vascular surgery. If myocardial infarction or cerebrovascular accidents has complicated the dissection, results are extremely poor, regardless of therapy. Patients with distal dissection have a good prognosis with medical therapy alone, unless aortic rupture or impending rupture, hematoma progression despite a maximal drug program, vital organ compromise, or inability to control pain or blood pressure medically supervene. Dissecting aneurysm of the aorta, while potentially a promptly fatal event, is amenable to aggressive therapy provided that one is alert to the possibility of this disease. Despite all technical advances, the single most important factor in making the diagnosis of dissecting aortic aneurysm is a strong index of suspicion on the part of the physician.