Įven in elderly patients with other comorbidities, surgical repair is the method of choice for the patients presenting with acute type A aortic dissection. Possible complications of aortic dissection include lethal malperfusion syndrome, aortic regurgitation, cardiac failure (myocardial infarction or cardiac tamponade) and stroke. With respect to the time from the onset of the symptoms, aortic dissections are divided into acute (presentation within 1 week), subacute (from 1 week to 1 month) and chronic (more than 1 month).įigure 1 Classification of aortic dissection according to Stanford and DeBakey (drawn by J. The older DeBakey system differentiates between dissections evolving from the ascending aorta and affecting all aortic segments (type I), less extensive ones affecting only the ascending fragment (type II), and dissections affecting only descending aorta (type III) (fig. According to the more popular Stanford system, dissections involving the ascending aorta are classified as type A, whereas those involving only the descending aorta are classified as type B. The classification of the aortic dissection is based on both anatomical location of the initial tear and the time from the onset of the symptoms to the presentation at the emergency department. The incidence of acute aortic syndromes in the general population ranges from 4 to 6 cases per 100 000 person-years, but increases up to 30 or more in people older than 65 years. IntroductionĪcute aortic syndrome refers to a group of interrelated life-threatening conditions and consists of aortic dissection, intramural haematoma and penetrating atherosclerotic ulcer. As yet, easily accessible blood tests play only a small role but have the potential to make diagnosis and monitoring of patients simpler and more cost-effective. Imaging provides a robust foundation for diagnosing acute aortic dissection, as well as for monitoring of patients at increased risk of aortic disease. However, patients with genetic connective tissue disorders such as Marfan, Loeys Dietz or Ehlers Danlos syndrome, and patients with bicuspid aortic valves are at the increased risk of aortic dissection at a much younger age. Advanced age, male gender, long-term history of arterial hypertension and the presence of aortic aneurysm confer the greatest population attributable risk. Typical symptoms of acute aortic dissection include severe chest pain, hypotension or syncope and, hence, mimic acute myocardial infarction or pulmonary embolism. Therefore, its prompt and proper diagnosis is vital to increase a patient’s chance of survival and to prevent grievous complications. Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients.
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