From the Guidelines
The most common anatomic site of acute aortic dissection is the right lateral wall of the ascending aorta (option A). Aortic dissections typically begin with a tear in the intimal layer of the aorta, allowing blood to enter the media and create a false lumen. The ascending aorta, particularly its right lateral wall, is especially vulnerable due to the hemodynamic stress it experiences from blood ejection from the left ventricle, as discussed in the context of thoracic aortic dissection management 1. This area experiences the greatest pressure and shear forces during cardiac systole. The right lateral wall is also subjected to more mechanical stress than other parts of the aorta due to its curvature and the directional flow of blood from the heart. Key points to consider in the management and diagnosis of aortic dissection include:
- Risk factors for aortic dissection, such as hypertension, connective tissue disorders like Marfan syndrome, bicuspid aortic valve, and atherosclerosis, as noted in the evaluation of adult patients with suspected acute nontraumatic thoracic aortic dissection 1.
- Patients typically present with sudden, severe chest pain often described as tearing or ripping in nature, which may radiate to the back or abdomen.
- Prompt diagnosis and management are crucial as mortality rates increase significantly with delayed treatment, highlighting the importance of early intervention in acute aortic dissection cases 1.
From the Research
Anatomic Site of Acute Aortic Dissection
The most common anatomic site of acute aortic dissection is not explicitly stated in the provided studies. However, based on the information given, we can infer the following:
- The ascending aorta is a common site for aortic dissection, particularly type A dissection 2, 3, 4.
- The descending thoracic aorta is also a common site for aortic dissection, particularly type B dissection 5, 6.
- The studies do not provide a clear answer to the question of which specific site (right lateral wall of ascending aorta, descending thoracic aorta below the ligamentum arteriosum, abdominal aorta above the renal arteries, or left lateral wall of the ascending aorta) is the most common.
Key Points
- Aortic dissection is a life-threatening condition that requires swift diagnostic confirmation and adequate treatment 5.
- The choice of approach for repairing or replacing the damaged region of the aorta depends on the severity and location of the dissection and the risks of complication from surgery 5.
- 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 5, 2, 4.
- Endovascular repair of ascending aortic pathologies is feasible in patients facing high risk with open surgery, with promising early results 4.