Head and Neck Pain in Patients Presenting with Acute Aortic Dissection

Background Head and neck pain is an atypical presentation of acute aortic dissection. Classic teaching associates this pain with proximal dissections, but this has not been extensively studied. Methods Patients enrolled in the International Registry of Acute Aortic Dissection from January 1996 to March 2015 were included in this study. We analyzed the demographics, presentation, treatment, and outcomes of Type A aortic dissection patients presenting with head and neck pain (n = 812, 25.8%) and compared it with those without these symptoms (n = 2,341, 74.2%). Results Patients with head and neck pain were more likely to be white, female, with a family history of aortic disease. Patients with head and neck pain had higher percentages of back pain (43.3% vs. 37.5%, p = 0.005) and chest pain (87.6% vs. 79.3%, p < 0.001). On imaging, a higher percentage of those with head and neck pain had arch vessel involvement (44.3% vs. 38%, p = 0.010) and intramural hematoma (11.7% vs. 8.1%, p = 0.003). Surgical management was more common in patients with head and neck pain (89.8% vs. 85.2%, p = 0.001). Regarding outcomes, patients with head and neck pain had significantly higher rates of stroke than those without head and neck pain (13% vs. 9.9%, p = 0.016); however, overall mortality was lower for those with head and neck pain (19.5% vs. 23%, p = 0.038). Those with head and neck pain only had higher overall mortality compared to those with head and neck pain with chest or back pain (34.6% vs. 19.9%, p = 0.013). A logistic regression of mortality revealed that preoperative hypotension and age > 65 years were significantly associated with increased mortality. Conclusion Presence of head and neck pain in Type A dissection is associated with more arch involvement, intramural hematoma, and stroke. When isolating those with head and neck pain only, there appear to be a higher rate of comorbidity burden and higher overall mortality.

Download Full-text

Optimal treatment strategy for type A acute aortic dissection with intramural hematoma

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2012.11.015 ◽

2014 ◽

Vol 147 (1) ◽

pp. 307-311 ◽

Cited By ~ 17

Author(s):

Mitsumasa Hata ◽

Hiroaki Hata ◽

Akira Sezai ◽

Isamu Yoshitake ◽

Shinji Wakui ◽

...

Keyword(s):

Aortic Dissection ◽

Treatment Strategy ◽

Acute Aortic Dissection ◽

Intramural Hematoma ◽

Type A ◽

Optimal Treatment ◽

Optimal Treatment Strategy

Download Full-text

Frank's sign with acute aortic dissection

10.22541/au.163846246.64225415/v1 ◽

2021 ◽

Author(s):

Hironobu Nishiori ◽

Yuichi Hirano ◽

Masayoshi Otsu ◽

Hiroyuki Watanabe

Keyword(s):

Computed Tomography ◽

Back Pain ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Young Patients ◽

Type A ◽

Aortic Disease ◽

Atherosclerotic Disease ◽

Smoking History

A 59-year-old man with a long smoking history presented with sudden back pain. Frank’s sign was noticed in his bilateral ears, and computed tomography revealed Stanford type A acute aortic dissection. If young patients have Frank’s sign, attention should be paid to atherosclerotic disease including aortic disease.

Download Full-text

Abstract 20003: A 15-year Analysis and Descriptive Study of the Incidence, Clinical Characteristics, Management, and Outcomes of Lower Limb Ischemia in Type A and Type B Aortic Dissection Patients: Insights From the International Registry of Acute Aortic Dissection

Circulation ◽

10.1161/circ.132.suppl_3.20003 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Susan Alaei ◽

Thoralf M Sundt ◽

Udo Sechtem ◽

Truls Myrmel ◽

Marco Di Eusanio ◽

...

Keyword(s):

Aortic Dissection ◽

Lower Limb ◽

Acute Aortic Dissection ◽

Limb Ischemia ◽

Type A ◽

Leg Pain ◽

Type B ◽

Lower Limb Ischemia ◽

Over Time ◽

Overall Mortality

Background: This study assessed the incidence of lower limb ischemia as well as trends in management and outcomes while examining acute aortic dissection patients over a period of 15 years. Additionally, differences in clinical presentation, interventions performed, and mortality between patients with and without lower limb ischemia were investigated. Methods: Lower limb ischemia (LLI) was evaluated among 3812 patients enrolled in the International Registry of Acute Aortic Dissection over a 15-year period that was separated into three 5-year intervals: 1996-2001, 2002-2007, and 2008-2012. The cohort was then divided by dissection type and presence or absence of LLI. Results: Type A patients presenting with limb ischemia (N=280, 11.4%) were much more likely to have atherosclerosis (p=0.021) and to present with back, abdominal and leg pain versus chest pain (p<0.001 unless noted). Other symptoms of malperfusion, including ischemic spinal cord damage (p<0.001) and coma/altered consciousness (p=0.006) were more common in patients presenting with LLI. Surgery was less commonly performed in Type A LLI patients (79.3% vs 86.1%, p=0.002), a difference that did not change over time (p=0.453, trend p=0.479). Additionally, overall mortality was higher in LLI patients (37.5% vs 22.9%, p<0.001) and did not show improvement among the LLI cohort over time. Type B patients with LLI (N=102, 7.5%) were more likely to be current smokers (p=0.028), to present febrile (p=0.022), and to have leg pain (p<0.001). As with Type A, ischemic spinal cord damage was more common in the LLI cohort (p<0.001). Patients with LLI were much more likely to be managed with endovascular therapy (19.6% vs 50.0%, p<0.001) than with medication alone (66.5% vs 29.4%, p<0.001), with endovascular repair increasing in LLI patients over time (p=0.008, trend p=0.002). Again, overall mortality was higher in the LLI cohort (24.5% vs 9.7%, p<0.001) and did not change over time. Conclusions: Although Type B patients with LLI received more endovascular procedures in later years, overall mortality did not improve. Increased complications and higher mortality in the LLI cohort suggests a need for better monitoring and increased implementation of interventions in this population.

Download Full-text