asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/1995-1477-2022-19-2-44-49asurgery-308Research ArticleАНГИОЛОГИЯANGIOLOGYАмбулаторное ведение пациентов после хирургических операций по поводу острого расслоения аорты типа АOutpatient management of patients after surgical operations for acute aortic dissection of type Ahttps://orcid.org/0000-0002-2560-7031КамалтдиновР. Р.KamaltdinovR. R.

Камалтдинов Руслан Рафаилович - аспирант кафедры сердечно-сосудистой и эндоваскулярной хирургии, Казанский ГМУ; врач сердечно-сосудистый хирург отделения сосудистой хирургии, Межрегиональный клинико-диагностический центр

420012, Казань, ул. Бутлерова, д. 49; 420101, Казань, ул. Карбышева, д. 12а

Ruslan R. Kamaltdinov - Рostgraduate Student of the Department of Cardiovascular and Endovascular Surgery, Kazan SMU; Cardiovascular Surgeon, Department of Vascular Surgery, Interregional Clinical Diagnostic Center

49, Butlerov St., Kazan, 420012; 12a, Karbyshev St., Kazan, 420101

ruslankgmu@yandex.ruhttps://orcid.org/0000-0001-8146-2263АхметзяновР. В.AkhmetzianovR. V.

Ахметзянов Рустем Вилевич - доктор медицинских наук, ассистент кафедры сердечно-сосудистой и эндоваскулярной хирургии, Казанский ГМУ; врач сердечно-сосудистый хирург отделения сосудистой хирургии, Межрегиональный клинико-диагностический центр;

420012, Казань, ул. Бутлерова, д. 49; 420101, Казань, ул. Карбышева, д. 12а

Rustem V. Akhmetzianov - Dr. Sci. (Med.), Professor, Department of Cardiovascular and Endovascular Surgery, Kazan SMU; Cardiovascular Surgeon, Department of Vascular Surgery, Interregional Clinical Diagnostic Center

49, Butlerov St., Kazan, 420012; 12a, Karbyshev St., Kazan, 420101

arustemv@mail.ruhttps://orcid.org/0000-0001-7160-3333БредихинР. А.BredikhinR. A.

Бредихин Роман Александрович - доктор медицинских наук, профессор, доцент кафедры сердечно-сосудистой и эндоваскулярной хирургии, Казанский ГМУ; заведующий отделением сосудистой хирургии, Межрегиональный клинико-диагностический центр

420012, Казань, ул. Бутлерова, д. 49; 420101, Казань, ул. Карбышева, д. 12а

Roman A. Bredikhin - Dr. Sci. (Med.), Professor, Department of Cardiovascular and Endovascular Surgery, Kazan SMU; Head of the Department of Vascular Surgery, Interregional Clinical Diagnostic Center

49, Butlerov St., Kazan, 420012; 12a, Karbyshev St., Kazan, 420101

rbredikhin@mail.ruДжорджикияР. К.DzhordzhikiyaR. K.

Джорджикия Роин Кондратьевич, доктор медицинских наук, профессор, заведующий кафедрой сердечно-сосудистой и эндоваскулярной хирургии, Казанский ГМУ; руководитель направления «Сердечно-сосудистая хирургия», Межрегиональный клинико-диагностический центр

420012, Казань, ул. Бутлерова, д. 49; 420101, Казань, ул. Карбышева, д. 12а

Roin K. Dzhordzhikiya - Dr. Sci. (Med.), Professor, Head of the Department of Cardiovascular and Endovascular Surgery, Kazan SMU; Head of the Direction Cardiovascular Surgery, Interregional Clinical Diagnostic Center;

49, Butlerov St., Kazan, 420012; 12a, Karbyshev St., Kazan, 420101

roink@mail.ruКазанский государственный медицинский университет; Межрегиональный клинико-диагностический центрРоссияKazan State Medical University; Interregional Clinical Diagnostic CenterRussian Federation2022191120221924449Copyright © Камалтдинов Р.Р., Ахметзянов Р.В., Бредихин Р.А., Джорджикия Р.К., 20222022Камалтдинов Р.Р., Ахметзянов Р.В., Бредихин Р.А., Джорджикия Р.К.Kamaltdinov R.R., Akhmetzianov R.V., Bredikhin R.A., Dzhordzhikiya R.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/308

Острое расслоение аорты типа A по-прежнему остается одним из самых сложных заболеваний, с которым сталкиваются врачи всех специальностей. Текущий обзор основан на анализе данных современной литературы и клинических рекомендаций. Он охватывает различные аспекты амбулаторного ведения пациентов и концентрируется на консервативной терапии. Отсутствие адекватного алгоритма диагностики достаточно часто приводит к возникновению осложнений и в конечном счете к летальному исходу. Динамический характер заболевания, вариативность клинических проявлений и течения патологического процесса требуют особого внимания. От тщательного наблюдения зависит как краткосрочное, так и долгосрочное выживание пациента. Послеоперационное ведение пациентов с острым расслоением аорты типа А полностью возлагается на амбулаторное звено, которое, вследствие отсутствия в современных клинических рекомендациях основных аспектов стратегии, не всегда подготовлено к курации этой сложной когорты пациентов. Отсутствие опыта ведения данной патологии врачами поликлиник вызывает значительные трудности в вопросах интерпретации инструментальных методов диагностики, что ведет к дальнейшей ошибочной тактике с развитием отдаленных осложнений. Ввиду отсутствия единой схемы медикаментозной терапии остается открытым и вопрос назначения препаратов у данных пациентов, зачастую получаю щих достаточно большой спектр лекарств по поводу сопутствующей патологии. Данные факторы способствуют полипрогмазии либо наоборот – недостаточному объему медикаментозной терапии, что в дальнейшем приводит к прогрессированию заболевания. В результате недостаточного акцента на основы амбулаторного ведения данной когорты пациентов возникает целый комплекс проблем, приводящий к неудовлетворительным результатам лечения и повышению расходов здравоохранения на последующее их решение. Целью обзора является освещение основных проблем данного вопроса с точки зрения доказательной медицины.

Acute aortic dissection of type A is still one of the most difficult diseases faced by doctors of all specialties. The current review is based on an analysis of current literature data and clinical guidelines. It covers various aspects of outpatient patient management and focuses on conservative therapy. The lack of an adequate diagnostic algorithm often leads to complications and, ultimately, death. The dynamic nature of the disease, the variability of clinical manifestations and the course of the pathological process require special attention. Both short-term and long-term survival of the patient depends on careful observation. Postoperative management of patients with acute aortic dissection of type A is entirely entrusted to the outpatient unit, which, due to the absence of the main aspects of the strategy in modern clinical recommendations, is not always prepared for the curation of this complex cohort of patients. The lack of experience in managing this pathology by outpatient hospital doctors causes significant difficulties in interpreting instrumental diagnostic methods, which leads to further erroneous tactics with the development of long-term complications. Due to the lack of a unified scheme of drug therapy, the question of prescribing drugs in these patients, who often receive a fairly large range of medications for concomitant pathology, remains open. These factors contribute to polyprogmasia or vice versa – insufficient volume of drug therapy, which further leads to the progression of the disease. As a result of insufficient emphasis on the basics of outpatient management of this cohort of patients, a whole complex of problems arises, leading to unsatisfactory treatment results and increased healthcare costs for their subsequent solution. The purpose of the review is to highlight the main problems of this issue from the point of view of evidence-based medicine.

острое расслоение аортыострый аортальный синдромпослеоперационное наблюдениеконсервативная терапия диссекций аортыacute aortic dissectionacute aortic syndromepostoperative follow-up conservative therapy of aortic dissectionReferencesАссоциация сердечно-сосудистых хирургов России. Клинические рекомендации по диагностике и лечению заболеваний аорты (2017). Кардиология и сердечно-сосудистая хирургия. 2018;11(1):7–67. Режим доступа: https://www.mediasphera.ru/issues/kardiologiya-i-serdechno-sosudistaya-khirurgiya/2018/1/1199663852018011007.Clinical guidelines. Guidelines for the diagnosis and treatment of aortic diseases (2017). Kardiologiya i Serdechno-Sosudistaya Khirurgiya. 2018;11(1):7–67. Available at: https://www.mediasphera.ru/issues/kardiologiya-i-serdechno-sosudistaya-khirurgi ya/2018/1/1199663852018011007.Bashir M., Harky A., Howard C., Bartram T. Type A Aortic Dissection in the United Kingdom: The Untold Facts. Semin Thorac Cardiovasc Surg. 2019;31(4):664–667. https://doi.org/10.1053/j.semtcvs.2019.06.011.Bashir M., Harky A., Howard C., Bartram T. Type A Aortic Dissection in the United Kingdom: The Untold Facts. Semin Thorac Cardiovasc Surg. 2019;31(4):664–667. https://doi.org/10.1053/j.semtcvs.2019.06.011.Gawinecka J., Schönrath F., Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly. 2017;147:w14489. https://doi.org/10.4414/smw.2017.14489.Gawinecka J., Schönrath F., Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly. 2017;147:w14489. https://doi.org/10.4414/smw.2017.14489.Wundram M., Falk V., Eulert-Grehn J., Herbst H., Thurau J., Leidel B. et al. Incidence of acute type A aortic dissection in emergency departments. Sci Rep. 2020;10(1):7434. https://doi.org/10.1038/s41598-020-64299-4.Wundram M., Falk V., Eulert-Grehn J., Herbst H., Thurau J., Leidel B. et al. Incidence of acute type A aortic dissection in emergency departments. Sci Rep. 2020;10(1):7434. https://doi.org/10.1038/s41598-020-64299-4.Rylski B., Georgieva N., Beyersdorf F., Büsch C., Boening A., Haunschild J. et al. German Registry for Acute Aortic Dissection Type A Working Group of the German Society of Thoracic, Cardiac, and Vascular Surgery. Gender-related differences in patients with acute aortic dissection type A. J Thorac Cardiovasc Surg. 2021;162(2):528–535.e1. https://doi.org/10.1016/j.jtcvs.2019.11.039.Rylski B., Georgieva N., Beyersdorf F., Büsch C., Boening A., Haunschild J. et al. German Registry for Acute Aortic Dissection Type A Working Group of the German Society of Thoracic, Cardiac, and Vascular Surgery. Gender-related differences in patients with acute aortic dissection type A. J Thorac Cardiovasc Surg. 2021;162(2):528–535.e1. https://doi.org/10.1016/j.jtcvs.2019.11.039.Malvindi P., Votano D., Ashoub A., Modi A., Miskolczi S., Velissaris T. et al. Age-related presentation of acute type A aortic dissection. Asian Cardiovasc Thorac Ann. 2018;26(9):659–666. https://doi.org/10.1177/0218492318810087.Malvindi P., Votano D., Ashoub A., Modi A., Miskolczi S., Velissaris T. et al. Age-related presentation of acute type A aortic dissection. Asian Cardiovasc Thorac Ann. 2018;26(9):659–666. https://doi.org/10.1177/0218492318810087.Fukui T., Tabata M., Morita S., Takanashi S. Gender differences in patients undergoing surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015;150(3):581–587.e1. https://doi.org/10.1016/j.jtcvs.2015.06.031.Fukui T., Tabata M., Morita S., Takanashi S. Gender differences in patients undergoing surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015;150(3):581–587.e1. https://doi.org/10.1016/j.jtcvs.2015.06.031.Gudbjartsson T., Ahlsson A., Geirsson A., Gunn J., Hjortdal V., Jeppsson A. et al. Acute type A aortic dissection – a review. Scand Cardiovasc J. 2020;54(1):1–13. https://doi.org/10.1080/14017431.2019.1660401.Gudbjartsson T., Ahlsson A., Geirsson A., Gunn J., Hjortdal V., Jeppsson A. et al. Acute type A aortic dissection – a review. Scand Cardiovasc J. 2020;54(1):1–13. https://doi.org/10.1080/14017431.2019.1660401.Howard D., Banerjee A., Fairhead J., Perkins J., Silver L., Rothwell P. Oxford Vascular Study. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013;127(20):2031–2037. https://doi.org/10.1161/CIRCULATIONAHA.112.000483.Howard D., Banerjee A., Fairhead J., Perkins J., Silver L., Rothwell P. Oxford Vascular Study. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013;127(20):2031–2037. https://doi.org/10.1161/CIRCULATIONAHA.112.000483.Ren Y., Huang S., Li Q., Liu C., Li L., Tan J. et al. Prognostic factors and prediction models for acute aortic dissection: a systematic review. BMJ Open. 2021;11(2):e042435. https://doi.org/10.1136/bmjopen-2020-042435.Ren Y., Huang S., Li Q., Liu C., Li L., Tan J. et al. Prognostic factors and prediction models for acute aortic dissection: a systematic review. BMJ Open. 2021;11(2):e042435. https://doi.org/10.1136/bmjopen-2020-042435.Sabe A., Percy E., Kaneko T., Plichta R., Hughes G. When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review. Ann Thorac Surg. 2021;111(6):1754–1762. https://doi.org/10.1016/j.athoracsur.2020.08.002.Sabe A., Percy E., Kaneko T., Plichta R., Hughes G. When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review. Ann Thorac Surg. 2021;111(6):1754–1762. https://doi.org/10.1016/j.athoracsur.2020.08.002.Zhang J., Jiang Y., Gao C., Feng J., Wang A. Risk factors for hospital death in patients with acute aortic dissection. Heart Lung Circ. 2015;24(4):348–353. https://doi.org/10.1016/j.hlc.2014.10.009.Zhang J., Jiang Y., Gao C., Feng J., Wang A. Risk factors for hospital death in patients with acute aortic dissection. Heart Lung Circ. 2015;24(4):348–353. https://doi.org/10.1016/j.hlc.2014.10.009.Wundram M., Falk V., Eulert-Grehn J., Herbst H., Thurau J., Leidel B. et al. Incidence of acute type A aortic dissection in emergency departments. Sci Rep. 2020;10(1):7434. https://doi.org/10.1038/s41598-020-64299-4.Wundram M., Falk V., Eulert-Grehn J., Herbst H., Thurau J., Leidel B. et al. Incidence of acute type A aortic dissection in emergency departments. Sci Rep. 2020;10(1):7434. https://doi.org/10.1038/s41598-020-64299-4.Nienaber C., Clough R. Management of acute aortic dissection. Lancet. 2015;385(9970):800–811. https://doi.org/10.1016/S01406736(14)61005-9.Nienaber C., Clough R. Management of acute aortic dissection. Lancet. 2015;385(9970):800–811. https://doi.org/10.1016/S01406736(14)61005-9.Baliyan V., Parakh A., Prabhakar A., Hedgire S. Acute aortic syndromes and aortic emergencies. Cardiovasc Diagn Ther. 2018;8(1):S82–S96. https://doi.org/10.21037/cdt.2018.03.02.Baliyan V., Parakh A., Prabhakar A., Hedgire S. Acute aortic syndromes and aortic emergencies. Cardiovasc Diagn Ther. 2018;8(1):S82–S96. https://doi.org/10.21037/cdt.2018.03.02.Morello F., Santoro M., Fargion A., Grifoni S., Nazerian P. Diagnosis and management of acute aortic syndromes in the emergency department. Intern Emerg Med. 2021;16(1):171–181. https://doi.org/10.1007/s11739-020-02354-8.Morello F., Santoro M., Fargion A., Grifoni S., Nazerian P. Diagnosis and management of acute aortic syndromes in the emergency department. Intern Emerg Med. 2021;16(1):171–181. https://doi.org/10.1007/s11739-020-02354-8.Córdoba-Soriano J., Hidalgo-Olivares V., Cambronero-Cortinas E., Fernández-Anguita M. Differential diagnosis of chest pain: a case of acute aortic syndrome. Semergen. 2014;40(2):e37–42. https://doi.org/10.1016/j.semerg.2012.12.006.Córdoba-Soriano J., Hidalgo-Olivares V., Cambronero-Cortinas E., Fernández-Anguita M. Differential diagnosis of chest pain: a case of acute aortic syndrome. Semergen. 2014;40(2):e37–42. https://doi.org/10.1016/j.semerg.2012.12.006.Paulis R.D., Peterss S., Pichlmaier M., Curtis A., Luehr M., Born F., Hagl C. Patient management in aortic arch surgery. Eur J Cardiothorac Surg. 2017;51(1):i4–i14. https://doi.org/10.1093/ejcts/ezw337.Paulis R.D., Peterss S., Pichlmaier M., Curtis A., Luehr M., Born F., Hagl C. Patient management in aortic arch surgery. Eur J Cardiothorac Surg. 2017;51(1):i4–i14. https://doi.org/10.1093/ejcts/ezw337.Weigang E., Nienaber C., Rehders T., Ince H., Vahl C., Beyersdorf F. Management of patients with aortic dissection. Dtsch Arztebl Int. 2008;105(38):639–645. https://doi.org/10.3238/arztebl.2008.0639.Weigang E., Nienaber C., Rehders T., Ince H., Vahl C., Beyersdorf F. Management of patients with aortic dissection. Dtsch Arztebl Int. 2008;105(38):639–645. https://doi.org/10.3238/arztebl.2008.0639.Nazerian P., Mueller C., Soeiro A., Leidel B., Salvadeo S., Giachino F. et al. Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study. Circulation. 2018;137(3):250–258. https://doi.org/10.1161/CIRCULATIONAHA.117.029457.Nazerian P., Mueller C., Soeiro A., Leidel B., Salvadeo S., Giachino F. et al. Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study. Circulation. 2018;137(3):250–258. https://doi.org/10.1161/CIRCULATIONAHA.117.029457.Evangelista A., Isselbacher E., Bossone E., Gleason T., Eusanio M., Sechtem U. et al. Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation. 2018;137(17):1846–1860. https://doi.org/10.1161/CIRCULATIONAHA.117.031264.Evangelista A., Isselbacher E., Bossone E., Gleason T., Eusanio M., Sechtem U. et al. Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation. 2018;137(17):1846–1860. https://doi.org/10.1161/CIRCULATIONAHA.117.031264.Deeb G., Williams D., Bolling S., Quint L., Monaghan H., Sievers J. et al. Surgical delay for acute type A dissection with malperfusion. Ann Thorac Surg. 1997;64(6):1669–1675. https://doi.org/10.1016/s0003-4975(97)01100-4.Deeb G., Williams D., Bolling S., Quint L., Monaghan H., Sievers J. et al. Surgical delay for acute type A dissection with malperfusion. Ann Thorac Surg. 1997;64(6):1669–1675. https://doi.org/10.1016/s0003-4975(97)01100-4.Norton E., Khaja M., Williams D., Yang B. Type A aortic dissection complicated by malperfusion syndrome. Curr Opin Cardiol. 2019;34(6):610–615. https://doi.org/10.1097/HCO.0000000000000667.Norton E., Khaja M., Williams D., Yang B. Type A aortic dissection complicated by malperfusion syndrome. Curr Opin Cardiol. 2019;34(6):610–615. https://doi.org/10.1097/HCO.0000000000000667.Порханов В.А., Печетов А.А., Митиш В.А., Звягин А.А., Коваленко А.Л. и др. Клинические рекомендации по хирургическому лечению больных послеоперационным медиастенитом и остеомиелитом грудины и ребер. Краснодар; Москва; 2014. 25 с. 2014. Режим доступа: http://xn----9sbdbejx7bdduahou3a5d.xn--p1ai/stranica-pravlenija/unkr/torakalnaja-hirurgija/klinicheskie-rekomendaci-po-hirurgicheskomu-lecheniyu-bolnyh-posleoperacionym-mediastinitom-i-osteomielitom-grudiny-i-reber.html.Porkhanov V.A., Pechetov A.A., Mitish V.A., Zvyagin A.A., Kovalenko A.L. et al. Clinical guidelines for the surgical treatment of patients with postsurgical mediastinitis and osteomyelitis of the sternum and ribs. Krasnodar; Moscow; 2014. 25 p.(In Russ.) Available at: http://xn----9sbdbejx7bdduahou3a5d.xn--p1ai/stranica-pravlenija/unkr/torakalnaja-hirurgija/klinicheskie-rekomendaci-pohirurgicheskomu-lecheniyu-bolnyh-posleoperacionym-mediastinitom-i-osteomielitom-grudiny-i-reber.html.Ohle R., Kareemi H., Wells G., Perry J. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis. Acad Emerg Med. 2018;25(4):397–412. https://doi.org/10.1111/acem.13360.Ohle R., Kareemi H., Wells G., Perry J. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis. Acad Emerg Med. 2018;25(4):397–412. https://doi.org/10.1111/acem.13360.Kodolitsch Y., Schwartz A., Nienaber C. Clinical prediction of acute aortic dissection. Arch Intern Med. 2000;160(19):2977–2982. https://doi.org/10.1001/archinte.160.19.2977.Kodolitsch Y., Schwartz A., Nienaber C. Clinical prediction of acute aortic dissection. Arch Intern Med. 2000;160(19):2977–2982. https://doi.org/10.1001/archinte.160.19.2977.Cui J., Jing Z., Zhuang S., Qi S., Li L.,Zhou J.et al. D-dimer as a biomarker for acute aortic dissection: a systematic review and metaanalysis. Medicine (Baltimore). 2015;94(4):e471. https://doi.org/10.1097/MD.0000000000000471.Cui J., Jing Z., Zhuang S., Qi S., Li L.,Zhou J.et al. D-dimer as a biomarker for acute aortic dissection: a systematic review and metaanalysis. Medicine (Baltimore). 2015;94(4):e471. https://doi.org/10.1097/MD.0000000000000471.Bima P., Pivetta E., Nazerian P., Toyofuku M., Gorla R., Bossone E. et al. Systematic Review of Aortic Dissection Detection Risk Score Plus D-dimer for Diagnostic Rule-out Of Suspected Acute Aortic Syndromes. Acad Emerg Med. 2020;27(10):1013–1027. https://doi.org/10.1111/acem.13969.Bima P., Pivetta E., Nazerian P., Toyofuku M., Gorla R., Bossone E. et al. Systematic Review of Aortic Dissection Detection Risk Score Plus D-dimer for Diagnostic Rule-out Of Suspected Acute Aortic Syndromes. Acad Emerg Med. 2020;27(10):1013–1027. https://doi.org/10.1111/acem.13969.Suzuki K., Kimura N., Mieno M., Hori D., Sezai A., Yamaguchi A., Tanaka M. Factors related to white blood cell elevation in acute type A aortic dissection. PLoS ONE. 2020;15(2):e0228954. https://doi.org/10.1371/journal.pone.0228954.Suzuki K., Kimura N., Mieno M., Hori D., Sezai A., Yamaguchi A., Tanaka M. Factors related to white blood cell elevation in acute type A aortic dissection. PLoS ONE. 2020;15(2):e0228954. https://doi.org/10.1371/journal.pone.0228954.Vrsalovic M., Vrsalovic-Presecki A., Aboyans V. N-terminal pro-brain natriuretic peptide and short-term mortality in acute aortic dissection: A meta-analysis. Clin Cardiol. 2020;43(11):1255–1259. https://doi.org/10.1002/clc.23436.Vrsalovic M., Vrsalovic-Presecki A., Aboyans V. N-terminal pro-brain natriuretic peptide and short-term mortality in acute aortic dissection: A meta-analysis. Clin Cardiol. 2020;43(11):1255–1259. https://doi.org/10.1002/clc.23436.Vrsalovic M. Prognostic effect of cardiac troponin elevation in acute aortic dissection: A meta-analysis. Int J Cardiol. 2016;214:277–278. https://doi.org/10.1016/j.ijcard.2016.03.230.Vrsalovic M. Prognostic effect of cardiac troponin elevation in acute aortic dissection: A meta-analysis. Int J Cardiol. 2016;214:277–278. https://doi.org/10.1016/j.ijcard.2016.03.230.Рудой А.С., Бова А.А., Мрочек А.Г., Нечаева Г.И., Арутюнов А.Г и др. Наднациональные международные рекомендации по наследуемым аневризмам и расслоениям грудной аорты 2018. Медицинский вестник Северного Кавказа. 2018;13(1–2):239. https://doi.org/10.14300/mnnc.2018.13038..Rudoi A.S., Bova A.A., Mrochek A.G., Nechaeva G.I., Arutyunov A.G. et al. Supranational (internation) guidelines for heritable thoracic aortic aneurysm and dissection. Medical News of North Caucasus. 2018;13(1–2):239. (In Russ.) https://doi.org/10.14300/mnnc.2018.13038.Erbel R., Aboyans V., Boileau C., Bossone E., Di Bartolomeo R., Eggebrecht H. и др. Рекомендации ESC по диагностике и лечению заболеваний аорты 2014. Российский кардиологический журнал. 2015;7(123):7–72. https://doi.org/10.15829/1560-4071-2015-7-7-72.Erbel R., Aboyans V., Boileau C., Bossone E., Di Bartolomeo R., Eggebrecht H. et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Russian Journal of Cardiology. 2015;7(123):7–72. (In Russ.) https://doi.org/10.15829/1560-4071-2015-7-7-72.Hiratzka L., Bakris G., Beckman J., Bersin R., Carr V., Casey D. et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. J Am Coll Cardiol. 2010;55(14):e102. https://doi.org/10.1016/j.jacc.2010.02.015.Hiratzka L., Bakris G., Beckman J., Bersin R., Carr V., Casey D. et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. J Am Coll Cardiol. 2010;55(14):e102. https://doi.org/10.1016/j.jacc.2010.02.015.Jovin I., Duggal M., Ebisu K., Paek H., Oprea A., Tranquilli M. et al. Comparison of the effect on long-term outcomes in patients with thoracic aortic aneurysms of taking versus not taking a statin drug. Am J Cardiol. 2012;109(7):1050–1054. https://doi.org/10.1016/j.amjcard.2011.11.038.Jovin I., Duggal M., Ebisu K., Paek H., Oprea A., Tranquilli M. et al. Comparison of the effect on long-term outcomes in patients with thoracic aortic aneurysms of taking versus not taking a statin drug. Am J Cardiol. 2012;109(7):1050–1054. https://doi.org/ 10.1016/j.amjcard.2011.11.038.Song S., Yoo K., Kim D., Cho B., Yi G., Chang B. Effects of early anticoagulation on the degree of thrombosis After repair of acute DeBakey type I aortic dissection. Ann Thorac Surg. 2011;92(4):1367–1374. https://doi.org/10.1016/j.athoracsur.2011.04.111.Song S., Yoo K., Kim D., Cho B., Yi G., Chang B. Effects of early anticoagulation on the degree of thrombosis After repair of acute DeBakey type I aortic dissection. Ann Thorac Surg. 2011;92(4):1367–1374. https://doi.org/10.1016/j.athoracsur.2011.04.111.Кобалава Ж.Д., Конради А.О., Недогода С.В., Шляхто Е.В., Арутюнов Г.П. и др. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(3):3786. https://doi.org/10.15829/1560-4071-2020-3-3786.Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyzkhto E.V., Arutyunov G.P. et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786. (In Russ.) https://doi.org/10.15829/1560-4071-2020-3-3786.Kodolitsch Y., Wilson O., Schüler H., Larena-Avellaneda A., Kölbel T., Wipper S. et al. Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS). Cardiovasc Diagn Ther. 2017;7(6):559–571. https://doi.org/10.21037/cdt.2017.07.01.Kodolitsch Y., Wilson O., Schüler H., Larena-Avellaneda A., Kölbel T., Wipper S. et al. Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS). Cardiovasc Diagn Ther. 2017;7(6):559–571. https://doi.org/10.21037/cdt.2017.07.01.Aboyans V., Bauersachs R., Mazzolai L., Brodmann M., Rodriguez-Palomares J., Sebastian Debus S. et al. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy. European Heart Journal. 2021;42(39):4013–4024. https://doi.org/10.1093/eurheartj/ehab390.Aboyans V., Bauersachs R., Mazzolai L., Brodmann M., Rodriguez-Palomares J., Sebastian Debus S. et al. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy. European Heart Journal. 2021;42(39):4013–4024. https://doi.org/10.1093/eurheartj/ehab390.Boodhwani M., Andelfinger G., Leipsic J., Lindsay T., McMurtry M., Therrien J., Siu S. Canadian Cardiovascular Society. Canadian Cardiovascular Society position statement on the management of thoracic aortic disease. Can J Cardiol. 2014;30(6):577–589. https://doi.org/10.1016/j.cjca.2014.02.018.Boodhwani M., Andelfinger G., Leipsic J., Lindsay T., McMurtry M., Therrien J., Siu S. Canadian Cardiovascular Society. Canadian Cardiovascular Society position statement on the management of thoracic aortic disease. Can J Cardiol. 2014;30(6):577–589. https://doi.org/10.1016/j.cjca.2014.02.018.Anderson T., Grégoire J., Hegele R., Couture P., Mancini G., McPherson R. 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2013;29(2):151–167. https://doi.org/10.1016/j.cjca.2012.11.032.Anderson T., Grégoire J., Hegele R., Couture P., Mancini G., McPherson R. 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2013;29(2):151–167. https://doi.org/10.1016/j.cjca.2012.11.032.

The authors declare that there are no conflicts of interest present.