The diagnosis and management of aortic dissection

#### Summary points Aortic dissection is caused by an intimal and medial tear in the aorta with propagation of a false lumen within the aortic media. It is part of the “acute aortic syndrome”—an umbrella term for aortic dissection, intramural haematoma, and symptomatic aortic ulcer (table⇓).1 Acute dissection is the most common aortic emergency, with an annual incidence of 3-4 per 100 000 in the United Kingdom and United States, which exceeds that of ruptured aneurysm.2 w1 w2 The prognosis is grave, with 20% preadmission mortality and 30% in-hospital mortality.2 View this table: European Society of Cardiologists’ classification of acute aortic syndrome The best treatment depends on the anatomical and temporal classification of the disease. Aortic dissection is therefore categorised according to the site of the entry tear and the time between the onset of symptoms and diagnosis. A dissection is considered “acute” when the diagnosis is made within 14 days of onset, and thereafter it is termed “chronic.” The location of the entry tear plays a key role in treatment and outcome, and it is classified by being in the ascending aorta (Stanford type A dissection) or distal to …