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Clinical Manifestations of Acute Aortic Dissection—Reply

Michael Klompas, MD
JAMA. 2002;288(7):828. doi:10.1001/jama.288.7.828.
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In Reply: Dr Sharpe correctly states that the panoply of different presentations of acute aortic dissection includes mesenteric ischemia. Indeed, symptoms of ischemia anywhere in the body should always prompt consideration of acute aortic dissection as a possible etiology. Despite a wealth of case series that have been published about aortic dissection, the relative frequency with which each of the different aortic dissection presentation syndromes occur is still unknown. The study that Sharpe cites,1 while informative, is representative of this gap in the literature as it derives an incidence of mesenteric ischemia from a selected population of patients (retrospectively identified aortic dissection seen at a tertiary referral center). Prospective studies of presenting signs and symptoms that reliably identify all patients who develop aortic dissection over a given period are still lacking. Until such studies are conducted to define the relative frequency of different presentation syndromes, a high index of suspicion for aortic dissection ought to be maintained for symptoms consistent with local ischemia anywhere in the body.


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