Unfortunately, it is a time-consuming and invasive procedure that exposes the patient to the risk of a contrast dye load and a small chance of further damage to the friable aortic lumen by the catheter. The primary argument in favor of aortography is the ability to identify the original tear and to visualize the coronary anatomy for concomitant bypass grafting. In younger patients without significant coronary risk factors, this step can be bypassed. Plain chest roentgenography is helpful in the presence of a widened mediastinum but cannot provide any further information. It is noninvasive and easily available, but it does not provide essential information regarding the degree of aortic root or great vessel involvement.
Contrast dye is required to make an accurate diagnosis.
The patient avoids a contrast dye load. Unfortunately, it is difficult, if not impossible, to monitor an unstable patient in a small tube for 30-45 mintues. Also, coronary anatomy is not well visualized. It occasionally shows coronary artery involvement. There is one area of the aorta near the proximal arch that is difficult to assess with TEE due to the interposition of the left mainstem bronchus between the aorta and esophagus, but this area can be seen by transthoracic echocardiography, which should also be performed.