Lessons Learnt from the International Registry of Acute Aortic Dissection (IRAD)
Acute aortic dissection is a life-threatening condition associated with high morbidity and mortality rates and a long history of challenges to both diagnose and manage this condition successfully. The International Registry of Acute Aortic Dissection (IRA
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Xun Yuan and Christoph A. Nienaber
20.1 Introduction
the role of chest X-rays in diagnosis of acute dissection diminished; surgical results for type Acute aortic dissection (AAD) is a life- A and type B aortic dissection improved; endothreatening condition with a population-based vascular therapies were applied increasingly for incidence of ~30 per 100,000 person-year in the type B dissection; beta blockers, angiotensin elderly (>65 years) population. The International receptor blockers (ARBs), diuretics, and statins Registry of Acute Aortic Dissection (IRAD) was were prescribed more frequently at hospital disestablished in 1996 with the idea to create a new charge following acute aortic dissection [1]; and understanding of this old disease including overall hospital mortality had improved for type demographics, presenting history, physical A aortic dissection but less so for type B aortic examination, imaging studies, and management. dissection (Table 20.1). The conception and implementation of the IRAD was inaugurated with the mission to IRAD database under the direction of Drs. Eric improve the care of dissection patients worldIsselbacher, Christoph Nienaber, and Kim Eagle wide, in the expectation that information from a represented a practical resource has contributed large registry will influence diagnostic and theraimmensely to the advancement in the manage- peutic management in the years to come. ment of aortic diseases with more than 80 peer- However, there are drawbacks as IRAD data reviewed publications. Since its inception, are collected retrospectively, there is no core laboIRAD has expanded to 43 active sites in 12 ratory for image analysis, and the tertiary referral countries in the USA, Europe, and Asia. A nature of the IRAD centres impairs its ability to recent trend analysis has shown that clinical be “representative of all patients with acute aortic presentation of acute aortic dissection had not dissection”. IRAD information comes from a changed. However, the use of computed tomog- referral hospital basis rather than a community raphy (CT) as a diagnostic modality increased; population basis, with subsequently some inherent potential for misleading statistics [2]. It would be helpful to have population-based information X. Yuan · C. A. Nienaber (*) Faculty of Medicine, Cardiology and Aortic Centre, in addition to knowledge of non-consecutive disRoyal Brompton & Harefield NHS Trust and sected patients only. Nevertheless, IRAD has shed Cardiovascular Department, National Heart and Lung tremendous light on the “silent killer” and “great Institute, Imperial College London, London, UK masquerader” or aortic dissection. e-mail: [email protected]; [email protected]
© Springer-Verlag GmbH Austria, part of Springer Nature 2019 O. H. Stanger et al. (eds.), Surgical Management of Aortic Pathology, https://doi.org/10.1007/978-3-7091-4874-7_20
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278 Table 20.1 Twelve important publications from the IRAD consortium First author, year of publication (Ref.#) Hagan
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