title: Aortic dissection.
abstract: 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.
authors.affiliation: Cardiology and Aortic Centre, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.|Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.affiliation: Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille), Lille, France.|Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Clough
authors.affiliation: Centre Hospitalier Universitaire de Liege, Department de Chirurgie Cardiovasculaire, Liege, Belgium.
authors.forename: Natzi
authors.initials: N
authors.lastname: Sakalihasan
authors.affiliation: Department of Cardiovascular Sciences, Cardiovascular Research Centre at Glenfield General Hospital, University of Leicester, Leicester, UK.
authors.forename: Toru
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Vascular Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Gibbs
authors.affiliation: Department of Vascular Surgery, Columbia University, New York, New York, USA.
authors.forename: Firas
authors.initials: F
authors.lastname: Mussa
authors.affiliation: Department of Vascular Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jenkins
authors.affiliation: Department of Vascular Surgery, St George's University of London, London, UK.
authors.forename: Matt M
authors.initials: MM
authors.lastname: Thompson
authors.affiliation: Department of Cardiology, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Cardiology and Aortic Centre, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.|Faculty of Medicine, Imperial College London, London, UK.
authors.forename: James S M
authors.initials: JS
authors.lastname: Yeh
authors.affiliation: Cardiology and Aortic Centre, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cheshire
authors.affiliation: Cardiology and Aortic Centre, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rosendahl
authors.affiliation: Cardiology and Aortic Centre, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.|Faculty of Medicine, Imperial College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Pepper
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery*; D001011:Aorta / Q000473:pathology / Q000503:physiopathology; D015415:Biomarkers / Q000032:analysis; D006348:Cardiac Surgical Procedures; D050171:Dyslipidemias / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D008279:Magnetic Resonance Imaging / Q000379:methods; D008382:Marfan Syndrome / Q000150:complications; D009026:Mortality; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D015415:Biomarkers