Managing Emergency Hypertension in Aortic Dissection and Aortic Aneurysm Surgery

  From a disease that just a few decades ago carried an ominous prognosis, aortic dissection has become a highly treatable condition. Similar development has occurred in regard to the treatment of thoracic aortic aneurysms. Treatment options are medical, surgical, or endovascular. Aortic dissection always presents as a hypertensive emergency and requires parenteral antihypertensive agents to control blood pressure (BP) and prevent target organ damage. Diligent control of BP is of utmost importance in order to stop the progression of dissection with possible aortic branch malperfusion. Treatment for hypertensive emergency begins in the intensive care unit and continues during and after surgery. Improved surgical techniques as well as newer, safer agents that reduce BP to acceptable levels have reduced the risk of mortality and improved prognosis in the postoperative period. Nevertheless, mortality rates remain high, and successful management of aortic dissection and aortic aneurysm still poses a clinical challenge.