The autopsy of King George II following his sudden death in 1760:
Historical Perspectives on Aortic Dissection
Abstract
Two hundred sixty years have passed since Frank Nicholls’ history-making observations and publication generated by the autopsy findings on King George II following his sudden death in 1760. Several decades later, the disease was named, attaching – for the first time – the terms dissection and dissecting to an aortic disease process. Another century went by before effective surgical treatment was developed. In sharp contrast, the evolution during the last 20+ years has been fast-paced and amazing. Our understanding of AD, while not yet complete, has improved dramatically. The introduction of nonsurgical endovascular therapy has had a profoundly transformative impact. Stent-graft repair has already largely replaced open surgery in the treatment of complicated type B AD. Predictably, such endovascular techniques will also have major future impact for patients presenting with acute type A dissection. Finally, and amidst the plethora of “good news,” it is appropriate to reflect on the formidable challenge that endovascular therapies face as they gear to compete with the much-improved optimal medical therapy in the management of patients with acute uncomplicated type B dissection. Long-term gains may well become the winning card when and if the late results of TEVAR can be shown to improve on the rather compromised outlook of medically treated dissection patients.
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