Prediction of aortic dissection
İbrahim Akın, Christoph Nienaber
Abstract
Aortic dissection is a low-incidence, high-impact and potentially catastrophic condition if not treated adequately and in time. Acute aortic dissection is diagnosed within 2 weeks of onset of symptoms, which is the high-mortality period. Patients surviving 2 weeks are considered to have subacute disease, and chronic aortic dissection is diagnosed after 8 weeks. The anatomical classification is based on the involvement of ascending aorta (type A according to Stanford) or not (type B).1 Historical data for untreated type A aortic dissection show a mortality rate of 1%–2% per hour within the first 24 hours, resulting in a mortality rate of up to 50%–74% during the acute phase.2 Uncomplicated acute type B dissection is less frequently lethal, with survival rates for medically treated patients of 84% at 1 year. Within the risk factors, arterial hypertension is dominating. It affects arterial wall composition, causing intimal thickening, fibrosis, and calcification and extracellular fatty acid deposition. The extracellular matrix also undergoes accelerated degradation, apoptosis and elastolysis with hyalinisation of collagen. Other risk factors in the elderly are atherosclerosis, prior cardiac surgery and known aortic aneurysms. On the contrary, hereditary conditions of aortopathology (eg, …