Acute aortic syndromes

Acute aortic syndromes comprise acute aortic dissection, intramural haematoma, symptomatic penetrating aortic ulcers and traumatic aortic dissection. These conditions result primarily from disruption of the outer aortic layer, and involve thinning of the aortic wall, increased wall stress, progressive dilatation, evolution of intramural haemorrhage, and possible dissection and rupture. Chronic hypertension and connective tissue disorders are often implicated. Echocardiography, contrast-enhanced CT, dynamic MRI and aortography are currently used to confirm the diagnosis. Aortic dissection is primarily classified according to anatomical characteristics; those with and without ascending aortic involvement are distinguished for prognostic and therapeutic reasons. In general, open surgery is indicated when dissection involves the ascending aorta, whereas medical management or endovascular stent-graft implantation are reserved for cases where the ascending aorta is spared. Pathology involving the aortic arch may be treated using a hybrid approach combining debranching of the head and neck vessels and interventional stent-graft implantation. Stent-graft induced remodelling of dissected aorta seems to have long-term benefits both in complicated and so-called uncomplicated distal dissection. In addition, long-term medical therapy to control hypertension is of paramount importance in all patients who have survived aortic dissection to reduce late complications, including recurrent dissection, aneurysm formation or late extension or rupture.