dissecting aortic aneurysm; aortic dissection (acute aortic syndrome)

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Includes acute aortic syndromes:


* rarely isolated to the infrarenal aorta



  • may occur at any age
  • mean age is 59 years
  • male/female ratio is 3/1


Clinical manifestations


Diagnostic procedures


* CT, MRI & TEE with equally reliable diagnostic value[5]


Differential diagnosis


* emergency surgery also indicated for Type A intramural hematoma[3]

* type B aortic dissection extending through the level of the of the origins of the renal arteries are not necessarily canditates for urgent surgery

More general terms


  1. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 243-45
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 262-264
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2012, 2015, 2018, 2021.
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. 4.0 4.1 Suzuki T et al. for the IRAD-Bio Investigators. Diagnosis of acute aortic dissection by D-dimer: The International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation 2009 May 26; 119:2702 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19433758
  5. 5.0 5.1 Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16831999
  6. Nienaber CA, Rousseau H, Eggebrecht H et al Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation. 2009 Dec 22;120(25):2519-28 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19996018
  7. 7.0 7.1 7.2 7.3 Hiratzka LF et al 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010 Jul 27;122(4):e410. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20233780 (corresponding NGC guideline withdrawn Nov 2015)
  8. 8.0 8.1 8.2 The NNT: Aortic Dissection Diagnostics and Likelihood Ratios, Explained http://www.thennt.com/lr/aortic-dissection/
    Klompas M Does this patient have an acute thoracic aortic dissection? JAMA. 2002 May 1;287(17):2262-72. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11980527
  9. Braverman AC Aortic dissection: prompt diagnosis and emergency treatment are critical. Cleve Clin J Med. 2011 Oct;78(10):685-96 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21968475
    Braverman AC Acute aortic dissection: clinician update. Circulation. 2010 Jul 13;122(2):184-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20625143
  10. Nienaber CA, Kische S, Rousseau H et al Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013 Aug;6(4):407-16 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23922146
  11. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015 Feb 28;385(9970):800-11. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25662791
  12. Lederle FA, Powell JT, Nienaber CA. Does intensive medical treatment improve outcomes in aortic dissection? BMJ. 2014 Sep 9;349:g5288. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25205491
  13. Lo BM. An evidence-based approach to acute aortic syndromes. Emerg Med Pract. 2013 Dec;15(12):1-23; quiz 23-4. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24804329
  14. Maddu KK, Shuaib W, Telleria J, Johnson JO, Khosa F. Nontraumatic acute aortic emergencies: Part 1, Acute aortic syndrome. AJR Am J Roentgenol. 2014 Mar;202(3):656-65. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24555605
  15. Mussa FF, Horton JD, Moridzadeh R et al Acute Aortic Dissection and Intramural Hematoma: A Systematic Review. JAMA. 2016 Aug 16;316(7):754-63. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27533160 Free Article
  16. 16.0 16.1 16.2 16.3 16.4 16.5 16.6 Grimm L Aortic Dissection: A Double-Barreled Threat. Medscape. Oct 3, 2022 https://reference.medscape.com/slideshow/aortic-dissection-6009191
  17. Hameed I, Cifu AS, Vallabhajosyula P Management of Thoracic Aortic Dissection. JAMA. Published online February 16, 2023. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36795378 https://jamanetwork.com/journals/jama/fullarticle/2801761

Patient information

aortic dissection patient information