Challenges to Acute Aortic Dissection in a Regional Hospital

Review

Challenges to Acute Aortic Dissection in a Regional Hospital

Michiya Kageyama,¹ Satoshi Koizumi,¹ Koichi Iwamatsu,¹ Fumiya Saito,¹ Tomohisa Sakata,¹ Ryu Umezono,¹ Haruka Yokoyama,¹ Masateru Kanai,¹ Sawa Takayama,¹ Masahide Aoyagi,¹ Masahisa Okuchi,¹ Kentaro Minami,² Shigeru Toyoda² and Teruo Inoue^1,2

¹Department of Cardiovascular Medicine, Nasu Red Cross Hospital, Otawara, Japan
²Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Mibu, Japan

Acute aortic dissection is often a life-threatening disorder; in particular, type A aortic dissection necessitates urgent surgical intervention. Therefore, in regions where there are no cardiovascular surgeons, its treatment is quite challenging. Our facility, the Nasu Red Cross Hospital, located in the northern part of Tochigi Prefecture, is a core hospital for advanced emergency medical care, with eight cardiologists who can provide emergency coronary angioplasty for patients with acute coronary syndrome. However, we have no cardiovascular surgery section, so it is challenging to treat patients who require urgent surgical intervention. Therefore, we promptly transfer patients with type A aortic dissection to 8 facilities inside and outside the prefecture that have cardiovascular surgery sections. In regional hospitals like ours, without cardiovascular surgeons, it is necessary to provide a qualified diagnosis, initiate treatment for patients with acute aortic dissection including immediate blood pressure lowering and pain control using narcotics, and transfer patients eligible for urgent surgical intervention promptly to facilities with cardiovascular surgery sections. For smooth patient transfer, it is essential to build a close medical cooperation system that has daily interactions.

Key words —— aortic dissection; cardiovascular surgery; emergency care; medical cooperation; regional hospital

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Tohoku J. Exp. Med., 2025 March, 265(3), 143-150.

Correspondence: Michiya Kageyama, M.D., Ph.D., Department of Cardiovascular Medicine, Nasu Red Cross Hospital, Nakadawara, Otawara, Tochigi 324-8666, Japan.

e-mail: michiyakageyama@gmail.com