From the Guidelines
Aortic dissection risk factors include genetic connective tissue disorders, family history of aortic disease, high-risk chest, back, or abdominal pain features, and known aortic valve disease, as identified in the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. The most significant risk factors for aortic dissection are:
- Genetic connective tissue disorders such as Marfan syndrome, Loeys-Dietz syndrome, and vascular Ehlers-Danlos syndrome, which significantly increase risk due to inherent aortic wall weakness, as stated in the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease 1.
- Family history of aortic dissection or thoracic aortic aneurysm, which suggests possible genetic predisposition, as mentioned in the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease 1.
- High-risk chest, back, or abdominal pain features, such as pain that is abrupt or instantaneous in onset, severe in intensity, or has a ripping, tearing, stabbing, or sharp quality, as identified in the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease 1.
- Known aortic valve disease, which can increase the risk of aortic dissection, as stated in the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease 1. Other risk factors include:
- Recent aortic manipulation (surgical or catheter-based) 1
- Known thoracic aortic aneurysm 1
- Turner syndrome, which affects 1 in 2,500 liveborn girls and results in cardiovascular defects, including bicuspid aortic valve and aortic coarctation, as mentioned in the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. It is essential to control hypertension, avoid stimulants, and perform regular imaging for those with known aortic disease, as well as provide genetic counseling for affected families, to prevent aortic dissection, as stated in the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1.
From the Research
Risk Factors for Aortic Dissection
- Hypertension is a major risk factor for aortic dissection, as it increases the stress on the aortic wall 2
- Marfan syndrome is a genetic disorder that can cause aortic dilation and increase the risk of aortic dissection 3, 4
- Aortic root dilation is a significant risk factor for aortic dissection, and patients with Marfan syndrome are at higher risk 3, 4
Medical Management of Aortic Dissection
- Beta-blockers are commonly used to treat aortic dissection, as they can help reduce blood pressure and decrease the stress on the aortic wall 5, 6
- Other antihypertensive medications, such as calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers, may also be used to treat aortic dissection 6
- Thoracic endovascular aortic repair (TEVAR) is a minimally invasive procedure that can be used to treat aortic dissection, especially in patients with complicated type B aortic dissection 5
Complications of Aortic Dissection
- Visceral ischemia is a serious complication of aortic dissection, and patients with this condition have a poor prognosis even with treatment 5
- Organ malperfusion is a significant risk factor for mortality in patients with aortic dissection, and early diagnosis and intervention are crucial to prevent mortality 5