ACR Appropriateness Criteria® Suspected Acute Aortic Syndrome
| Autor: | Richard K.J. Brown, Saurabh Rajpal, Andrew M. Davis, Nandini M. Meyersohn, Todd C. Villines, Lynne M. Hurwitz Koweek, Brian B. Ghoshhajra, Christopher D. Maroules, Garth M. Beache, Samuel Wann, Joe Y. Hsu, Diana Litmanovich, Bruce M. Lo, Suhny Abbara, Seth Kligerman, Gregory Kicska, Faisal Khosa |
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| Rok vydání: | 2021 |
| Předmět: |
Acute aortic syndrome
Aortic dissection medicine.medical_specialty business.industry Lumen (anatomy) Chest pain medicine.disease Appropriate Use Criteria Penetrating atherosclerotic ulcer Back pain medicine Radiology Nuclear Medicine and imaging Radiology medicine.symptom business Medical literature |
| Zdroj: | Journal of the American College of Radiology. 18:S474-S481 |
| ISSN: | 1546-1440 |
| Popis: | Acute aortic syndrome (AAS) includes the entities of acute aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. AAS typically presents with sudden onset of severe, tearing, anterior, or interscapular back pain. Symptoms may be dominated by malperfusion syndrome, due to obstruction of the lumen of the aorta and/or a side branch when the intimal and medial layers are separated. Timely diagnosis of AAS is crucial to permit prompt management; for example, early mortality rates are reported to be 1% to 2% per hour after the onset of symptoms for untreated ascending aortic dissection. The appropriateness assigned to each imaging procedure was based on the ability to obtain key information that is used to plan open surgical, endovascular, or medical therapy. This includes, but is not limited to, confirming the presence of AAS; classification; characterization of entry and reentry sites; false lumen patency; and branch vessel compromise. Using this approach, CT, CTA, and MRA are all considered usually appropriate in the initial evaluation of AAS if those procedures include intravenous contrast administration. Ultrasound is also considered usually appropriate if the acquisition is via a transesophageal approach. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. |
| Databáze: | OpenAIRE |
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