Aortic dissection is a life-threatening condition caused by a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation (dissection) of the layers of the aortic wall. Aortic dissection is most common in those 65–75 years of age, with an incidence of 35 cases per 100,000 people per year in this population. Other risk factors include hypertension, dyslipidaemia and genetic disorders that involve the connective tissue, such as Marfan syndrome. Swift diagnostic confirmation and adequate treatment are crucial in managing affected patients. Contemporary management is multidisciplinary and includes serial non-invasive imaging, biomarker testing and genetic risk profiling for aortopathy. The choice of approach for repairing or replacing the damaged region of the aorta depends on the severity and the location of the dissection and the risks of complication from surgery. Open surgical repair is most commonly used for dissections involving the ascending aorta and the aortic arch, whereas minimally invasive endovascular intervention is appropriate for descending aorta dissections that are complicated by rupture, malperfusion, ongoing pain, hypotension or imaging features of high risk. Recent advances in the understanding of the underlying pathophysiology of aortic dissection have led to more patients being considered at substantial risk of complications and, therefore, in need of endovascular intervention rather than only medical or surgical intervention.
This is a preview of subscription content
Subscribe to Journal
Get full journal access for 1 year
only $59.00 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Clough, R. E. & Nienaber, C. A. Management of acute aortic syndrome. Nat. Rev. Cardiol. 12, 103–114 (2015).
Vilacosta, I. & Roman, J. A. Acute aortic syndrome. Heart 85, 365–368 (2001).
Erbel, R. et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur. Heart J. 35, 2873–2926 (2014). This paper describes a multidisciplinary guideline highlighting the changing trends in the management of acute aortic conditions.
Nienaber, C. A. 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. 6, 407–416 (2013). This paper reports the first randomized long-term comparison between medical management and pre-emptive stent grafting in Stanford type B aortic dissection, showing a long-term benefit using the latter approach.
Nienaber, C. A. & Clough, R. E. Management of acute aortic dissection. Lancet 385, 800–811 (2015). This article provides the most recent update on changing trends in the management of aortic dissection.
Bickerstaff, L. K. et al. Thoracic aortic aneurysms: a population-based study. Surgery 92, 1103–1108 (1982).
Clouse, W. D. et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin. Proc. 79, 176–180 (2004).
Olsson, C., Thelin, S., Stahle, E., Ekbom, A. & Granath, F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation 114, 2611–2618 (2006).
Acosta, S. et al. Increasing incidence of ruptured abdominal aortic aneurysm: a population-based study. J. Vasc. Surg. 44, 237–243 (2006).
Mehta, R. H. et al. Chronobiological patterns of acute aortic dissection. Circulation 106, 1110–1115 (2002).
Collins, J. S. et al. Differences in clinical presentation, management, and outcomes of acute type a aortic dissection in patients with and without previous cardiac surgery. Circulation 110, II237–II242 (2004).
Suzuki, T. et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation 108 (Suppl. 1), II312–II317 (2003).
Ramanath, V. S., Oh, J. K., Sundt, T. M. 3rd & Eagle, K. A. Acute aortic syndromes and thoracic aortic aneurysm. Mayo Clin. Proc. 84, 465–481 (2009).
Feldman, M., Shah, M. & Elefteriades, J. A. Medical management of acute type A aortic dissection. Ann. Thorac Cardiovasc. Surg. 15, 286–293 (2009).
Thrumurthy, S. G., Karthikesalingam, A., Patterson, B. O., Holt, P. J. & Thompson, M. M. The diagnosis and management of aortic dissection. BMJ 344, d8290 (2012).
Landenhed, M. et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. J. Am. Heart Assoc. 4, e001513 (2015). This paper provides a prospective analysis of 30,412 middle-aged individuals with 20 years of follow-up, reporting 15 cases per 100,000 patient-years for aortic dissection with a male preponderance.
Howard, D. P. et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation 127, 2031–2037 (2013). This article describes a population-based study reporting an aortic dissection incidence of 35 cases per 100,000 patient-years in those 65–75 years of age.
Nienaber, C. A. et al. Gender-related differences in acute aortic dissection. Circulation 109, 3014–3021 (2004).
Bossone, E. et al. Acute aortic dissection in blacks: insights from the International Registry of Acute Aortic Dissection. Am. J. Med. 126, 909–915 (2013).
Yeh, T. Y. et al. Epidemiology and medication utilization pattern of aortic dissection in Taiwan: a population-based study. Medicine (Baltimore) 94, e1522 (2015). This article demonstrates that the incidence of aortic dissection is rising in China and Japan alongside a high prevalence of arterial hypertension.
Hagan, P. G. et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 283, 897–903 (2000). This paper reports contemporary figures on the outcomes of Stanford type A and Stanford type B aortic dissection as a function of surgical or medical management from the International Registry for Aortic Dissection.
Evangelista, A. et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur. J. Echocardiogr. 11, 645–658 (2010).
Hirsch, A. T. et al. ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease) — summary of recommendations. J. Vasc. Interv. Radiol. 17, 1383–1397 (2006).
von Kodolitsch, Y. et al. Intramural hematoma of the aorta: predictors of progression to dissection and rupture. Circulation 107, 1158–1163 (2003).
Yin, H. & Pickering, J. G. Cellular senescence and vascular disease: novel routes to better understanding and therapy. Can. J. Cardiol. 32, 612–623 (2016).
Pape, L. A. et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J. Am. Coll. Cardiol. 66, 350–358 (2015).
Januzzi, J. L. et al. Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J. Am. Coll. Cardiol. 43, 665–669 (2004).
Nienaber, C. A. Diabetes mellitus and thoracic aortic disease: are people with diabetes mellitus protected from acute aortic dissection? J. Am. Heart Assoc. 1, e001404 (2012).
Milewicz, D. M. & Regalado, E. S. Use of genetics for personalized management of heritable thoracic aortic disease: how do we get there? J. Thorac Cardiovasc. Surg. 149, S3–S5 (2015).
Ziganshin, B. A. et al. Routine genetic testing for thoracic aortic aneurysm and dissection in a clinical setting. Ann. Thorac Surg. 100, 1604–1611 (2015). This is an interesting report on the clinical experience of routine genetic testing in non-syndromic and syndromic patients with aortic aneurysm and dissection.
Pyeritz, R. E. Recent progress in understanding the natural and clinical histories of the Marfan syndrome. Trends Cardiovasc. Med. 26, 423–428 (2016).
Deng, H. et al. Identification of a novel missense FBN2 mutation in a Chinese family with congenital contractural arachnodactyly using exome sequencing. PLoS ONE 11, e0155908 (2016).
Pyeritz, R. E. & McKusick, V. A. The Marfan syndrome: diagnosis and management. N. Engl. J. Med. 300, 772–777 (1979).
Loeys, B. L. et al. Aneurysm syndromes caused by mutations in the TGF-β receptor. N. Engl. J. Med. 355, 788–798 (2006).
Habashi, J. P. et al. Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science 312, 117–121 (2006).
Michelena, H. I. et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA 306, 1104–1112 (2011).
Guo, D. C. et al. LOX mutations predispose to thoracic aortic aneurysms and dissections. Circ. Res. 118, 928–934 (2016).
Kuang, S. Q. et al. FOXE3 mutations predispose to thoracic aortic aneurysms and dissections. J. Clin. Invest. 126, 948–961 (2016).
Barbier, M. et al. MFAP5 loss-of-function mutations underscore the involvement of matrix alteration in the pathogenesis of familial thoracic aortic aneurysms and dissections. Am. J. Hum. Genet. 95, 736–743 (2014).
Davies, R. R. et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann. Thorac Surg. 73, 17–27; discussion 27–28 (2002).
Kim, J. B. et al. Risk of rupture or dissection in descending thoracic aortic aneurysm. Circulation 132, 1620–1629 (2015).
Pape, L. A. et al. Aortic diameter > or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation 116, 1120–1127 (2007). This is an interesting report from the International Registry for Aortic Dissection supporting the observation that the ascending aorta dissects at a normal diameter or at a diameter of <55 mm in half of patients with Stanford type A aortic dissection.
Humphrey, J. D., Schwartz, M. A., Tellides, G. & Milewicz, D. M. Role of mechanotransduction in vascular biology: focus on thoracic aortic aneurysms and dissections. Circ. Res. 116, 1448–1461 (2015).
Ye, P. et al. GM-CSF contributes to aortic aneurysms resulting from SMAD3 deficiency. J. Clin. Invest. 123, 2317–2331 (2013).
Bellini, C., Wang, S., Milewicz, D. M. & Humphrey, J. D. Myh11 (R247C/R247C) mutations increase thoracic aorta vulnerability to intramural damage despite a general biomechanical adaptivity. J. Biomech. 48, 113–121 (2015).
Son, B. K. et al. Granulocyte macrophage colony-stimulating factor is required for aortic dissection/intramural haematoma. Nat. Commun. 6, 6994 (2015).
Ju, X. et al. Interleukin-6–signal transducer and activator of transcription-3 signaling mediates aortic dissections induced by angiotensin II via the T-helper lymphocyte 17–interleukin 17 axis in C57BL/6 mice. Arterioscler. Thromb. Vasc. Biol. 33, 1612–1621 (2013).
Anzai, A. et al. Adventitial CXCL1/G-CSF expression in response to acute aortic dissection triggers local neutrophil recruitment and activation leading to aortic rupture. Circ. Res. 116, 612–623 (2015).
Boyle, J. J., Weissberg, P. L. & Bennett, M. R. Tumor necrosis factor-α promotes macrophage-induced vascular smooth muscle cell apoptosis by direct and autocrine mechanisms. Arterioscler. Thromb. Vasc. Biol. 23, 1553–1558 (2003).
Ju, X. et al. IL-6 regulates extracellular matrix remodeling associated with aortic dilation in a fibrillin-1 hypomorphic mgR/mgR mouse model of severe Marfan syndrome. J. Am. Heart Assoc. 3, e000476 (2014).
Nienaber, C. A. & Eagle, K. A. Aortic dissection: new frontiers in diagnosis and management: part II: therapeutic management and follow-up. Circulation 108, 772–778 (2003).
Clough, R. E., Waltham, M., Giese, D., Taylor, P. R. & Schaeffter, T. A new imaging method for assessment of aortic dissection using four-dimensional phase contrast magnetic resonance imaging. J. Vasc. Surg. 55, 914–923 (2012). This article introduces 4D phase-contrast MRI for functional imaging of aortic dissection.
Frauenfelder, T. et al. Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings. Eur. Radiol. 19, 789–799 (2009).
Moore, A. G. et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). Am. J. Cardiol. 89, 1235–1238 (2002).
Elefteriades, J. A. et al. Indications and imaging for aortic surgery: size and other matters. J. Thorac Cardiovasc. Surg. 149, S10–S13 (2015).
Redheuil, A. et al. Age-related changes in aortic arch geometry: relationship with proximal aortic function and left ventricular mass and remodeling. J. Am. Coll. Cardiol. 58, 1262–1270 (2011).
Lederle, F. A. et al. Variability in measurement of abdominal aortic aneurysms. Abdominal Aortic Aneurysm Detection and Management Veterans Administration Cooperative Study Group. J. Vasc. Surg. 21, 945–952 (1995).
Singh, K. et al. Intra- and interobserver variability in the measurements of abdominal aortic and common iliac artery diameter with computed tomography. The Tromsø study. Eur. J. Vasc. Endovasc. Surg. 25, 399–407 (2003).
Cayne, N. S. et al. Variability of maximal aortic aneurysm diameter measurements on CT scan: significance and methods to minimize. J. Vasc. Surg. 39, 811–815 (2004).
Wen, D., Du, X., Dong, J. Z., Zhou, X. L. & Ma, C. S. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection. Heart 99, 1192–1197 (2013). This article provides an interesting analysis of D-dimer and C-reactive protein as common biomarkers to predict in-hospital death from acute aortic dissection.
Okina, N. et al. Utility of measuring C-reactive protein for prediction of in-hospital events in patients with acute aortic dissection. Heart Vessels 28, 330–335 (2013).
Jing, Q. et al. Angiotensin-converting enzyme I/D polymorphism and the risk of thoracic aortic dissection in Chinese Han population. Mol. Biol. Rep. 40, 1249–1254 (2013).
Treasure, T. & Pepper, J. The potential of personalized external aortic root support (PEARS) to restore and maintain aortic valve competence. Ann. Thorac Surg. 100, 2415 (2015). This paper describes the introduction of a personalized external aortic root support to prevent enlargement of the ascending aorta in aortopathy.
Trimarchi, S. et al. Descending aortic diameter of 5.5 cm or greater is not an accurate predictor of acute type B aortic dissection. J. Thorac Cardiovasc. Surg. 142, e101–e107 (2011).
Mehta, R. H. et al. Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. J. Am. Coll. Cardiol. 40, 685–692 (2002).
Cooley, D. A. & De Bakey, M. E. Resection of entire ascending aorta in fusiform aneurysm using cardiac bypass. J. Am. Med. Assoc. 162, 1158–1159 (1956).
DeBakey, M. E. et al. Surgical management of dissecting aneurysms of the aorta. J. Thorac Cardiovasc. Surg. 49, 130–149 (1965).
Wheat, M. W. Jr, Wilson, J. R. & Bartley, T. D. Successful replacement of the entire ascending aorta and aortic valve. JAMA 188, 717–719 (1964).
Bentall, H. & De Bono, A. A technique for complete replacement of the ascending aorta. Thorax 23, 338–339 (1968).
Yacoub, M. H. et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J. Thorac Cardiovasc. Surg. 115, 1080–1090 (1998).
David, T. E. & Feindel, C. M. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J. Thorac Cardiovasc. Surg. 103, 617–621; discussion 622 (1992). This article reports the introduction of the surgical aortic valve-sparing concept for patients with aneurysm of the ascending aorta.
Cabrol, C., Gandjbakhch, I. & Cham, B. [Aneurysms of the ascending aorta; total replacement with reimplantation of the coronary arteries (author's transl)]. Nouv. Presse Med. 7, 363–365 (in French) (1978).
Karck, M. et al. The frozen elephant trunk technique: a new treatment for thoracic aortic aneurysms. J. Thorac Cardiovasc. Surg. 125, 1550–1553 (2003).
Sayer, D. et al. Aortic morphology following endovascular repair of acute and chronic type B aortic dissection: implications for management. Eur. J. Vasc. Endovasc. Surg. 36, 522–529 (2008).
Dake, M. D. et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N. Engl. J. Med. 340, 1546–1552 (1999).
Nienaber, C. A. et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N. Engl. J. Med. 340, 1539–1545 (1999).
Cochennec, F. et al. Hybrid repair of aortic arch dissections. J. Vasc. Surg. 57, 1560–1567 (2013). This paper outlines endovascular stenting and associated vascular re-routing surgery for the treatment of dissection that encroaches onto the aortic arch.
Canaud, L. et al. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann. Surg. 260, 389–395 (2014).
Lombardi, J. V. et al. Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design. J. Vasc. Surg. 55, 629–640.e2 (2012).
Nienaber, C. A. et al. Provisional extension to induce complete attachment after stent-graft placement in type B aortic dissection: the PETTICOAT concept. J. Endovasc. Ther. 13, 738–746 (2006).
VIRTUE Registry Investigators. Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE Registry. Eur. J. Vasc. Endovasc. Surg. 48, 363–371 (2014).
Fattori, R. et al. Complicated acute type B dissection: is surgery still the best option?: A report from the International Registry of Acute Aortic Dissection. JACC Cardiovasc. Interv. 1, 395–402 (2008).
Parker, J. D. & Golledge, J. Outcome of endovascular treatment of acute type B aortic dissection. Ann. Thorac Surg. 86, 1707–1712 (2008).
Patterson, B. et al. Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic Thoracic Endovascular Registry (MOTHER) database. Circulation 127, 24–32 (2013).
Conrad, M. F. et al. Late aortic remodeling persists in the stented segment after endovascular repair of acute complicated type B aortic dissection. J. Vasc. Surg. 62, 600–605 (2015).
Trimarchi, S. et al. Role and results of surgery in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation 114, I357–I364 (2006).
Bozinovski, J. & Coselli, J. S. Outcomes and survival in surgical treatment of descending thoracic aorta with acute dissection. Ann. Thorac Surg. 85, 965–970; discussion 970–971 (2008).
Corvera, J. S. & Fehrenbacher, J. W. Open repair of chronic aortic dissections using deep hypothermia and circulatory arrest. Ann. Thorac Surg. 94, 78–81; discussion 82–83 (2012).
Kouchoukos, N. T., Kulik, A. & Castner, C. F. Outcomes after thoracoabdominal aortic aneurysm repair using hypothermic circulatory arrest. J. Thorac Cardiovasc. Surg. 145, S139–S141 (2013).
Mommertz, G. et al. Thoracoabdominal aortic aneurysm repair in patients with Marfan syndrome. Eur. J. Vasc. Endovasc. Surg. 35, 181–186 (2008).
Pujara, A. C. et al. Open repair of chronic distal aortic dissection in the endovascular era: implications for disease management. J. Thorac Cardiovasc. Surg. 144, 866–873 (2012).
Estrera, A. L. et al. Early and late outcomes after complete aortic replacement. Ann. Thorac Surg. 100, 528–534 (2015).
Tian, D. H., De Silva, R. P., Wang, T. & Yan, T. D. Open surgical repair for chronic type B aortic dissection: a systematic review. Ann. Cardiothorac. Surg. 3, 340–350 (2014).
Coselli, J. S. et al. Mortality and paraplegia after thoracoabdominal aortic aneurysm repair: a risk factor analysis. Ann. Thorac Surg. 69, 409–414 (2000).
Geisbusch, P. et al. Thoracic aortic endografting in patients with connective tissue diseases. J. Endovasc. Ther. 15, 144–149 (2008).
Drinkwater, S. L. et al. The incidence of spinal cord ischaemia following thoracic and thoracoabdominal aortic endovascular intervention. Eur. J. Vasc. Endovasc. Surg. 40, 729–735 (2010).
Bisdas, T., Panuccio, G., Sugimoto, M., Torsello, G. & Austermann, M. Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms. J. Vasc. Surg. 61, 1408–1416 (2015).
Griepp, E. B. et al. The anatomy of the spinal cord collateral circulation. Ann. Cardiothorac Surg. 1, 350–357 (2012).
Verhoeven, E. L. et al. Editor's choice — ten-year experience with endovascular repair of thoracoabdominal aortic aneurysms: results from 166 consecutive patients. Eur. J. Vasc. Endovasc. Surg. 49, 524–531 (2015).
Augoustides, J. G., Stone, M. E. & Drenger, B. Novel approaches to spinal cord protection during thoracoabdominal aortic interventions. Curr. Opin. Anaesthesiol. 27, 98–105 (2014).
Griepp, R. B. & Di Luozzo, G. Hypothermia for aortic surgery. J. Thorac Cardiovasc. Surg. 145, S56–S58 (2013).
Zipfel, B. et al. Spinal cord ischemia after thoracic stent-grafting: causes apart from intercostal artery coverage. Ann. Thorac Surg. 96, 31–38 (2013).
Etz, C. D. et al. Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair. J. Thorac Cardiovasc. Surg. 139, 1464–1472 (2010). This article reports that the staged repair of thoraco-abdominal aneurysm reduces the rate of paraplegia in this condition.
Etz, C. D., Debus, E. S., Mohr, F. W. & Kolbel, T. First-in-man endovascular preconditioning of the paraspinal collateral network by segmental artery coil embolization to prevent ischemic spinal cord injury. J. Thorac Cardiovasc. Surg. 149, 1074–1079 (2015).
Lohse, F. et al. Quality of life after replacement of the ascending aorta in patients with true aneurysms. Tex. Heart Inst. J. 36, 104–110 (2009).
Immer, F. F. et al. Improvement of quality of life after surgery on the thoracic aorta: effect of antegrade cerebral perfusion and short duration of deep hypothermic circulatory arrest. Circulation 110, II250–II255 (2004).
Chaddha, A. et al. Survivors of aortic dissection: activity, mental health, and sexual function. Clin. Cardiol. 38, 652–659 (2015). This is the first report on changes in physical activities, mental health and sexual function after aortic dissection.
Tang, G. H. et al. Surgery for acute type A aortic dissection in octogenarians is justified. J. Thorac Cardiovasc. Surg. 145, S186–S190 (2013).
Fattori, R. et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J. Am. Coll. Cardiol. 61, 1661–1678 (2013).
Svensson, L. G. et al. Aortic valve and ascending aorta guidelines for management and quality measures. Ann. Thorac Surg. 95, S1–S66 (2013). This paper presents the most recent guidelines for managing disease of the aortic valve and ascending aorta, including measures on quality of life.
Nienaber, C. A., Divchev, D., Palisch, H., Clough, R. E. & Richartz, B. Early and late management of type B aortic dissection. Heart 100, 1491–1497 (2014).
Suzuki, T. et al. Type-selective benefits of medications in treatment of acute aortic dissection (from the International Registry of Acute Aortic Dissection [IRAD]). Am. J. Cardiol. 109, 122–127 (2012).
Sakalihasan, N. et al. (Tissue PET) Vascular metabolic imaging and peripheral plasma biomarkers in the evolution of chronic aortic dissections. Eur. Heart J. Cardiovasc. Imaging 16, 626–633 (2015). This paper describes a study that found that PET imaging of aortic wall inflammation correlates with biomarker activity and may have prognostic usefulness in the chronic phase of aortic dissection.
Hertault, A. et al. Benefits of completion 3D angiography associated with contrast enhanced ultrasound to assess technical success after EVAR. Eur. J. Vasc. Endovasc. Surg. 49, 541–548 (2015).
Ulug, P., McCaslin, J. E., Stansby, G. & Powell, J. T. Endovascular versus conventional medical treatment for uncomplicated chronic type B aortic dissection. Cochrane Database Syst. Rev. 11, CD006512 (2012).
Metcalfe, M. J. et al. The first endovascular repair of an acute type A dissection using an endograft designed for the ascending aorta. J. Vasc. Surg. 55, 220–222 (2012).
Sobocinski, J. et al. Endovascular approaches to acute aortic type A dissection: a CT-based feasibility study. Eur. J. Vasc. Endovasc. Surg. 42, 442–447 (2011). This paper describes radiographic evaluation of CT images in proximal aortic dissection, with results suggesting that endovascular treatment is suitable for approximately 50% of patients.
Moon, M. C. et al. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy. J. Vasc. Surg. 53, 942–949 (2011).
Lu, Q. et al. Endovascular repair of ascending aortic dissection: a novel treatment option for patients judged unfit for direct surgical repair. J. Am. Coll. Cardiol. 61, 1917–1924 (2013). This paper describes the introduction of endovascular repair of the ascending aorta in cases of Stanford type A aortic dissection that are not suitable for surgical repair.
Idrees, J., Roselli, E. E., Shafii, S., Reside, J. & Lytle, B. W. Outcomes after false lumen embolization with covered stent devices in chronic dissection. J. Vasc. Surg. 60, 1507–1513 (2014).
Oikonomou, K. et al. Outcomes of fenestrated/branched endografting in post-dissection thoracoabdominal aortic aneurysms. Eur. J. Vasc. Endovasc. Surg. 48, 641–648 (2014).
Sobocinski, J. et al. Treatment options for postdissection aortic aneurysms. J. Cardiovasc. Surg. (Torino) 57, 202–211 (2016).
Bonatti, J., Vetrovec, G., Riga, C., Wazni, O. & Stadler, P. Robotic technology in cardiovascular medicine. Nat. Rev. Cardiol. 11, 266–275 (2014).
Saratzis, A. & Bown, M. J. The genetic basis for aortic aneurysmal disease. Heart 100, 916–922 (2014).
Callewaert, B., De Paepe, A. & Coucke, P. Arterial tortuosity syndrome. GeneReviewshttp://www.ncbi.nlm.nih.gov/books/NBK253404/ (updated 13 Nov 2014).
Schubert, J. A., Landis, B. J., Shikany, A. R., Hinton, R. B. & Ware, S. M. Clinically relevant variants identified in thoracic aortic aneurysm patients by research exome sequencing. Am. J. Med. Genet. A 170, 1288–1294 (2016).
Guo, D. C. et al. MAT2A mutations predispose individuals to thoracic aortic aneurysms. Am. J. Hum. Genet. 96, 170–177 (2015).
Guo, D. C. et al. Recurrent gain-of-function mutation in PRKG1 causes thoracic aortic aneurysms and acute aortic dissections. Am. J. Hum. Genet. 93, 398–404 (2013).
Pyeritz, R. E. Heritable thoracic aortic disorders. Curr. Opin. Cardiol. 29, 97–102 (2014).
Clough, R. E., Zymvragoudakis, V. E., Biasi, L. & Taylor, P. R. Usefulness of new imaging methods for assessment of type B aortic dissection. Ann. Cardiothorac Surg. 3, 314–318 (2014).
Nienaber, C. A. & Powell, J. T. Management of acute aortic syndromes. Eur. Heart J. 33, 26–35b (2012).
LeMaire, S. A. & Russell, L. Epidemiology of thoracic aortic dissection. Nat. Rev. Cardiol. 8, 103–113 (2011).
Donati, T., Wilson, J., Kolbel, T. & Clough, R. E. Modern diagnostics for type B aortic dissection. Gefasschirurgie 20, 420–427 (2015).
Baldwin, A. K., Simpson, A., Steer, R., Cain, S. A. & Kielty, C. M. Elastic fibres in health and disease. Expert Rev. Mol. Med. 15, e8 (2013).
Shalhub, S., Dua, A. & Brooks, J. Biomarkers in descending thoracic aortic dissection. Semin. Vasc. Surg. 27, 196–199 (2014).
The authors declare no competing interests.
About this article
Cite this article
Nienaber, C., Clough, R., Sakalihasan, N. et al. Aortic dissection. Nat Rev Dis Primers 2, 16053 (2016). https://doi.org/10.1038/nrdp.2016.53
A methylprednisolone-loaded and core-shell nanofiber-covered stent-graft to prevent inflammation and reduce degradation in aortic dissection
Biomaterials Research (2022)
Prevalence, clinical features, risk factors, and outcomes of SLE patients with aortic aneurysm: a cross-sectional retrospective study in a Chinese single center
Clinical Rheumatology (2022)
Potential predictors of severe cardiovascular involvement in Marfan syndrome: the emphasized role of genotype–phenotype correlations in improving risk stratification—a literature review
Orphanet Journal of Rare Diseases (2021)
Retrospective analysis of factors associated with aortic remodeling in patients with Stanford type B aortic dissection after thoracic endovascular aortic repair
Journal of Cardiothoracic Surgery (2021)
Admission white blood cell count predicts post-discharge mortality in patients with acute aortic dissection: data from the MIMIC-III database
BMC Cardiovascular Disorders (2021)