Cath Lab Digest

Figure 1 depicts a newspaper article that appeared shortly after Richard Holbrooke’s recent passing from acute aortic dissection. It represents a clear portrayal of the old-and-current state of equivocation that exists in regard to these equally dangerous but very different pathologies affecting the aorta. For reasons not altogether clear to me, lay peopleand physicians alike continue to think of aortic dissection and aortic aneurysm as if they were one and the same. Nothing could be further from the truth.

Aortic dissection does tend to occur on patients in their 60s and 70s who are often afflicted with multiple cardiovascular risk factors — same as aortic aneurysms. But that’s where the similarities end. It is true that dissection can lead to aneurysm formation as the false lumen dilates, and this can be called – appropriately – a dissecting aneurysm. However, aneurysm is just one of many possible evolving complications from a dissection.

Aortic aneurysm, the disease, on the other hand, begins as an aneurysm from the outset. It is a well-defined and distinct pathology that, among other things, carries important genetic and familial implications with the consequent need for screening of blood relatives, etc.

Admittedly, both diseases have significant potential for rupture and death, but they are clearly different, sharing only a few things in common. Isn’t it time that the medical community — if not the community at large — come to this understanding and call things what they really are once and for all? Am I the only one bothered by the state of perpetual confusion and misinformation in this area?

Frank J. Criado, MD, FACS, FSVM

__________________________________________________________________________

Dr. Frank J Criado is a Board-Certified Vascular Surgeon and Endovascular Specialist at the Union Memorial Hospital-MedStar Health in Baltimore, Maryland – USA.

Dr. Criado is widely acknowledged to be a pioneer in endovascular therapy, with a 20-year + interventional experience. He has contributed extensively to the literature with more than 100 peer-reviewed published articles – mostly on various vascular and endovascular subjects, and Editor-in-Chief of Vascular Disease Management (VDM). He has also been active in clinical research, with a major focus on aortic stent-graft and carotid interventions, and endovascular technologies in general. He was the National Principal Investigator (P.I.) for the Medtronic Talent AAA clinical trials in the U.S., and a member of the Executive Committee for the Medtronic Valor Thoracic trial.

He is a founding member and immediate past President of the International Society of Endovascular Specialists (ISES), founder and current President of the endovascular surgery society of Latinamerica (CELA), and a member of all major U.S. and international vascular and endovascular societies. He is a Fellow of the American College of Surgeons (FACS) and of the Society of Vascular Medicine (FSVM), and a member of the Board of Directors of the Society for Vascular Surgery (SVS).