TY - CHAP M1 - Book, Section TI - Ascending Thoracic Aorta and Aortic Arch A1 - Gaines, Thomas E. A2 - Dieter, Robert S. A2 - Dieter, Raymond A. A2 - Dieter, Raymond A. PY - 2009 T2 - Peripheral Arterial Disease AB - The diagnosis and management of disorders of the ascending aorta and aortic arch remain as formidable challenges in cardiovascular medicine and surgery. Until the advent of the modern era of cardiac surgery with cardiopulmonary bypass, this region of the aorta was all but inaccessible to any surgical intervention and even now definitive medical therapies remain elusive. Accurate diagnosis requires the sophisticated, yet now readily available, imaging techniques developed over the past few decades and rarely can be made on clinical grounds alone. While not as prevalent as atherosclerotic peripheral and coronary arterial occlusive disease, diseases of the proximal aorta are common enough that cardiovascular specialists are inevitably confronted with them in many different clinical settings. The sometimes enigmatic but dramatic and lethal presentation of ascending aortic dissection (AD) has attracted considerable public attention in recent years (See, for example, the 2004 Pulitzer Prize winning series by Kevin Helliker and Thomas Burton of The Wall Street Journal). Dissection and rupture, often occurring in otherwise vigorous individuals, are catastrophic biomechanical failures, and the end result of many different aortic pathologies. Aneurysmal degeneration is a common manifestation of proximal aortic disease and precedes many, but not all, instances of dissection. Congenital disease often involves obstructive lesions while atherosclerosis in this region does not. Yet even in the absence of luminal narrowing or aneurysm, the changes in aortic compliance or stiffness that accompany disease and aging have important pathophysiologic effects not only downstream in other organ systems but upstream in the heart. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesscardiology.mhmedical.com/content.aspx?aid=1127167387 ER -