![]() Using a similar analytic approach, the authors demonstrated that over the past 25 years there has been a shift in management trends for type B dissections to less surgical management (6.1%), less medical management (60.7%) and more endovascular management (31.2%). In addition to data on type A aortic dissections, IRAD maintains data on patients presenting with type B aortic dissections. Risk factors associated with long-term survival included age ≥70, post-procedural stroke and post-procedural tamponade. Despite an improvement in in-hospital mortality, 5-year post-discharge survival remained unchanged at 88.5% in the most current tertile. In-hospital mortality with medical management remained unchanged at 50.7%. This decrease was driven by a significant decline in the in-hospital mortality rate for surgically managed patients to 13.0%. Importantly, for type A dissection patients, the overall in-hospital mortality in the most current time period decreased significantly to 16.3%. Most type A dissections were diagnosed by CT scan and surgical management increased significantly to 88.6% in the past five years while the frequency of pre-operative stroke decreased to 3.9%. ![]() Hypertension, smoking and atherosclerosis were the three most common risk factors, with the frequency of hypertension increasing to 81.5% in the most recent tertile. To describe trends over time, patients were divided into three tertiles. ![]() Kim Eagle presented an overview of AAD over the past 25 years on behalf of the IRAD investigators. As such, the International Registry of Acute Aortic Dissection (IRAD) was developed in 1996 to better improve outcomes with AAD.Īs a consortium of over 55 large referral centers from 13 countries, IRAD maintains data on approximately 9,000 AAD patients. ![]() Quality improvement in AAD management has been limited by the emergent nature in which AADs present as well as the low incidence of AAD relative to conditions such as acute coronary syndrome. Effective management requires timely diagnosis and rapid treatment, yet even under ideal circumstances morbidity and mortality remain high. Please follow this link for the companion articles.Īcute aortic dissection (AAD) continues to be one of the most lethal cardiovascular conditions. The Asylum Division also adjudicates applications to suspend deportation or cancel removal under the Nicaraguan Adjustment and Central American Relief Act (NACARA).Īdditionally, the Asylum Division conducts credible fear screenings for people placed in expedited removal reasonable fear screenings for people subject to final administrative removal orders or reinstatement of prior removal orders screenings for people processed under the Migrant Protection Protocols and screening functions under bilateral asylum cooperative agreements.Editor's Note: This Expert Analysis is part of a series presenting perspectives on major ACC.19 trials. and, generally, are not already in removal proceedings. The Asylum Division adjudicates affirmative asylum applications for people who are already in the U.S. IRAD works regularly with anti-fraud, law enforcement, intelligence, and national security colleagues to protect adjudication integrity. Adjudicate immigration petitions and applications, such as requests for parole for urgent humanitarian reasons or significant public benefit.Conduct protection screenings for certain migrants interdicted at sea and.Interview refugee applicants identified for possible resettlement to the United States.IRAD also manages RAIO’s international offices and overseas workloads. Refugee Admissions Program (USRAP), along with the Department of State and other USRAP partners. The International and Refugee Affairs Division (IRAD ) administers the U.S. Two divisions oversee RAIO’s primary adjudicative programs: RAIO leverages its domestic and overseas presence to assess eligibility for humanitarian and immigration benefits throughout the world while combating fraud and protecting national security.
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