Acil Serviste Aort Diseksiyonu: Olgu Sunumu
Özet
Aort diseksiyonu (AD), ani başlangıçlı, şiddetli göğüs ağrısı ile karakterize, potansiyel olarak ölümcül bir vasküler acildir. Klinik sunumu klasik semptomların yanı sıra atipik bulgularla da olabilir. FM bulguları spesifik olmayabilir; bu nedenle yüksek klinik şüphe ve acil görüntüleme yöntemleri tanıda kritik önemdedir. AD acil müdahale gerektiren bir durumdur. Tanı konulmadığı veya tedavi geciktiği takdirde mortalite hızla artar. Özellikle Tip A diseksiyonlarında cerrahi acilen gerekli iken, Tip B olgularında ise medikal yönetim veya endovasküler tedavi tercih edilmektedir. Bu bölümde AD ile acil servise başvuran bir olgunun klinik tanı ve tedavisi içeren yönetimi literatür eşliğinde tartışılarak sunulmuştur.
Aortic dissection (AD) is a potentially fatal vascular emergency characterized by sudden onset of severe chest pain. Its clinical presentation may include atypical findings in addition to classic symptoms. Physical examination findings may not be specific; therefore, high clinical suspicion and urgent imaging methods are critical for diagnosis. AD is a condition requiring urgent intervention. Mortality increases rapidly if the diagnosis is not made or treatment is delayed. While surgery is urgently required, especially in Type A dissections, medical management or endovascular treatment is preferred in Type B cases. The management of a patient presenting to the emergency department with AD, including clinical diagnosis and treatment, is discussed with reference to the literature.
Referanslar
Bojko MM, Fleischman F. Aortic Dissection: Diagnosis. Cardiol Clin. 2025;43(2):209-217. doi: 10.1016/j.ccl.2024.11.001.
Zhang Z, Wang H, Kan X, et al. The interplay of ferroptosis and oxidative stress in the pathogenesis of aortic dissection. Front Pharmacol. 2025, 5;16:1519273. doi: 10.3389/fphar.2025.1519273.
Calderon-Martinez E, Velasco WV, Guo D, et al. Differences in Arterial Events in Vascular Ehlers-Danlos, Loeys-Dietz, and Marfan Syndrome. J Am Coll Cardiol. 2025 ,24;85(24):2355-2367. doi: 10.1016/j.jacc.2025.04.023.
Clothier JS, Kobsa S. Management of Acute Type A Aortic Dissection. Cardiol Clin. 2025 ;43(2):261-277. doi: 10.1016/j.ccl.2025.01.003.
Khoynezhad AB, Kay BZ, Kay HS, White RA. Current Management of Uncomplicated Type B Aortic Dissection. Ann Vasc Surg. 2025;114:350-357. doi: 10.1016/j.avsg.2024.12.014
Borghese O, Vincenzoni C, Nocerino M, Mangiacotti LP, Tshomba Y. Conservative Treatment of Retrograde Aortic Dissection After Endovascular or Hybrid Repair of Descending Aorta Pathologies. Ann Vasc Surg. 2025;112:63-70. doi: 10.1016/j.avsg.2024.11.099.
Peng GY, Wang M, Yao C, et al. Long Term Outcomes of Endovascular Treatment for Retrograde Ascending Aortic Dissection. Eur J Vasc Endovasc Surg. 2025;70(1):57-66. doi: 10.1016/j.ejvs.2025.02.041.
8.Knox A, Gimpel D, Lance D, et al. Outcomes of type A aortic dissection in Australia. ANZ J Surg. 2025;95(6):1122-1128. doi: 10.1111/ans.19399.
Isselbacher EM, Preventza O, Hamilton Black J 3rd, Augoustides JG, Beck AW, Bolen MA,et al.; Peer Review Committee Members. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 146(24):e334-e482. doi: 10.1161/CIR.0000000000001106.
Chen H, Duan J. Comparison and analysis of the diagnostic value of color doppler ultrasound and CT for abdominal aortic dissection aneurysm. J Cardiothorac Surg. 2025;21(1):47. doi: 10.1186/s13019-025-03775-2. Hesami M, Denkewicz R, Boivin Z, Bhalodkar S, Li JJ, Moore C. Association of dilated aortic root on point-of-care ultrasound with aortic aneurysm and dissection. Am J Emerg Med. 2025;95:89-94. doi: 10.1016/j.ajem.2025.05.039.
Kelava M, Alfirevic A, Geube M, et al. Intraoperative Transesophageal Echocardiography in Acute Type A Aortic Dissection: Contemporary Approach. J Am Soc Echocardiogr. 2025;38(6):498-508. doi: 10.1016/j.echo.2025.03.017.
Bojko MM, Fleischman F. Aortic Dissection: Diagnosis. Cardiol Clin. 2025;43(2):209-217. doi: 10.1016/j.ccl.2024.11.001.
Reed MJ. Diagnosis and management of acute aortic dissection in the emergency department. Br J Hosp Med (Lond). 2024;85(4):1-9. doi: 10.12968/hmed.2023.0366. PMID: 38708978.
Yalzadeh D, Tabibian K, Sakowitz S, et al. Surgical repair of type A aortic dissection at safety-net hospitals across the United States. Surgery. 2026;191:110040. doi: 10.1016/j.surg.2025.110040.
Clothier JS, Kobsa S. Management of Acute Type A Aortic Dissection. Cardiol Clin. 2025;43(2):261-277. doi: 10.1016/j.ccl.2025.01.003.
Matei DC, Robu C, Ciobanu CG, et al. Mortality in acute type A aortic dissection - A systematic review based on contemporary registries. Rom J Intern Med. 2025 ;63(3):209-220. doi: 10.2478/rjim-2025-0015.
