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Overview and Recommendations
Background
- •Understand that aortic dissection involves the longitudinal separation of the aortic wall layers, typically initiated by an intimal tear or primary medial hemorrhage that creates a false lumen separate from the true lumen.
- •Classify the condition using the Stanford system: Type A involves the ascending aorta (regardless of the tear site) and requires emergent surgery, while Type B is distal to the left subclavian artery and is primarily managed medically unless complications arise.
- •Recognize the temporal phases of the disease: Hyperacute (within 24 hours), Acute (1–14 days), Subacute (15–90 days), and Chronic (beyond 90 days), noting that the acute phase carries the highest risk of spontaneous rupture.
- •Identify key risk factors, most notably chronic (associated with a 2.5-fold increased risk), bicuspid aortic valve, and genetic connective tissue disorders such as or Loeys-Dietz syndrome.
- •Be aware of the "AAS spectrum" which includes classic dissection, (IMH)—bleeding within the wall without a visible tear—and (PAU), which can progress to full dissection.
- •Note the emerging association with pharmacological triggers, specifically fluoroquinolones, which may induce collagen degradation and increase the risk of aortic events within 30 days of exposure.
Evaluation
- •Suspect aortic dissection in any patient presenting with sudden-onset, "tearing," "ripping," or "stabbing" chest or back pain that is maximal at its inception.
- •Ask about pain migration, as the movement of pain from the chest to the back or abdomen often tracks the distal propagation of the dissection flap.
- •Measure blood pressure in both arms simultaneously; a systolic blood pressure differential >20 mmHg is a classic sign of brachiocephalic or subclavian artery involvement.
- •Perform a thorough four-limb pulse exam to identify pulse deficits, which occur when the false lumen compresses the true lumen or the flap occludes branch vessels.
- •Auscultate for a new diastolic decrescendo murmur at the right sternal border, indicating acute due to aortic root dilation or leaflet prolapse.
- •Screen for neurological deficits, including hemiparesis or altered mental status (carotid involvement) and paraplegia (spinal cord ischemia from intercostal artery involvement).
- •Utilize the Aortic Dissection Detection Risk Score (ADD-RS) to categorize patients into low, intermediate, or high clinical suspicion based on predisposing factors and exam findings.
- •Order a D-dimer test for patients with low clinical suspicion (ADD-RS ≤ 1); a value <500 ng/mL has a high negative predictive value and can effectively rule out the diagnosis.
- •Obtain a 12-lead ECG to rule out primary , but remain vigilant as 10-20% of Type A dissections involve the coronary ostia (usually the RCA), causing ST-elevation.
- •Order (CTA) of the chest, abdomen, and pelvis as the gold standard diagnostic test, providing nearly 99% sensitivity and specificity.
- •Perform bedside Transthoracic Echocardiography (TTE) in unstable patients to rapidly screen for pericardial effusion, cardiac tamponade, or severe aortic root dilation.
- •Consider Transesophageal Echocardiography (TEE) in the operating room or for patients with contraindications to CT contrast to visualize the intimal flap and valve function.
Management
- •Initiate "anti-impulse therapy" immediately upon suspicion to reduce the rate of ventricular contraction (dP/dt) and systemic wall stress.
- •Administer intravenous beta-blockers as first-line therapy; use Esmolol (500 mcg/kg bolus, then 50–200 mcg/kg/min) or Labetalol (20 mg IV bolus every 10 minutes) to achieve a target heart rate of ≤60 bpm.
- •Ensure heart rate is controlled before adding vasodilators to prevent reflex tachycardia, which can accelerate dissection propagation.
- •Target a systolic blood pressure between 100 and 120 mmHg; if BP remains elevated after beta-blockade, add Nitroprusside (0.25–10 mcg/kg/min) or Nicardipine (5–15 mg/hr).
- •Consult Cardiac Surgery emergently for all Stanford Type A dissections; these are surgical emergencies requiring replacement of the ascending aorta to prevent tamponade or rupture.
- •Transfer patients with Type A dissection to high-volume aortic centers, ideally using a "Direct-to-OR" protocol to bypass emergency department delays.
- •Manage uncomplicated Stanford Type B dissections in an ICU setting with aggressive medical therapy (BP and HR control) and serial imaging.
- •Perform (TEVAR) for "complicated" Type B dissections, defined by malperfusion, rupture, refractory pain, or rapid aortic expansion.
- •Prioritize endovascular reperfusion (stenting) in stable patients with malperfusion syndrome (e.g., mesenteric ischemia) before proceeding to open aortic repair.
- •Avoid the administration of thrombolytics or anticoagulants until dissection is definitively ruled out, as these agents can be fatal if a dissection is present.
- •Monitor for acute kidney injury (AKI) and maintain adequate mean arterial pressure (MAP) to ensure spinal cord and visceral perfusion.
- •Implement long-term blood pressure control with a target of <120/80 mmHg using beta-blockers as the backbone of therapy to reduce the risk of late aneurysmal expansion.
- •Refer patients under age 60 for genetic counseling and screening of first-degree relatives to identify familial thoracic aortic aneurysm syndromes.
- •Advise patients to avoid heavy isometric lifting (e.g., weightlifting) and fluoroquinolone antibiotics, which may increase the risk of future aortic events.
Board Review — High Yield
- •Tearing/Ripping Pain — The classic description of pain that is maximal at onset, unlike the crescendo pain of MI.
- •BP Differential — A difference of >20 mmHg between arms suggests the dissection involves the aortic arch/subclavian artery.
- •Stanford Type A — Involves the ascending aorta; always a surgical emergency regardless of the entry tear location.
- •Fluoroquinolones — Black box warning: avoid in patients with aortic disease due to increased risk of dissection/rupture.
- •Cystic Medial Necrosis — The classic histopathological finding in the aortic media, especially in Marfan syndrome.
- •D-dimer — Useful only for its high negative predictive value (NPV) to rule out dissection in low-risk patients.
- •Beta-blockers before Vasodilators — Essential sequence to prevent reflex tachycardia and increased aortic wall shear stress.
- •1% to 2% per hour — The mortality rate of untreated acute Type A aortic dissection in the first 24-48 hours.
Deep Dive — Evidence Details
Definition, Synonyms, and Classification
- ▸Stanford Type A involves the ascending aorta; Type B is distal to the left subclavian artery.
- ▸DeBakey Type I (extensive) is more common in younger patients, while Type II (isolated ascending) is more common in older patients.
- ▸The SVS/STS classification differentiates Stanford Type A into SVS/STS-A and SVS/STS-B0 based on the entry tear location.
- ▸Intramural hematoma (IMH) is part of the acute aortic syndrome spectrum and often shares pathophysiology with classic dissection.
- ▸The Penn classification provides a clinical risk stratification based on the presence and type of ischemia.
- ▸Aortic dissection can masquerade as a code stroke, requiring rapid CT-angiography of the arch and cervical arteries.
Definition and Pathophysiology
Aortic dissection (AD) is a life-threatening cardiovascular emergency characterized by the separation of the layers of the aortic wall. This process typically involves an intimal tear that allows blood to enter the media, creating a false lumen [16]D[17]D. While historically distinguished from intramural hematoma (IMH)—which was thought to originate from ruptured vasa vasorum without an intimal tear—modern imaging has identified small intimomedial tears in many IMH cases, blurring the distinction between these entities within the spectrum of acute aortic syndrome (AAS) [9]D. Acute aortic dissection may also present as a "code stroke" mimic; in a large cohort of 2,874 code stroke patients, approximately 54.4% had acute ischemia, but a subset of these neurological deficits were secondary to the proximal extension of an aortic dissection [5].
Stanford and DeBakey Classifications
The two primary anatomical classification systems remain the Stanford and DeBakey systems, which guide surgical versus medical management [278]C.
- Stanford Classification: Categorizes dissections based on the involvement of the ascending aorta [19]D.
- Type A: Involves the ascending aorta, regardless of the site of the primary tear [15]D.
- Type B: Involves only the aorta distal to the left subclavian artery [23]D.
- DeBakey Classification: Categorizes based on the origin and extent of the dissection [274].
- Type I: Originates in the ascending aorta and extends at least to the aortic arch, often further distally [277].
- Type II: Originates in and is confined to the ascending aorta [274].
- Type III: Originates in the descending aorta and extends distally [16]D.
Recent evidence suggests that DeBakey Type I and Type II represent distinct clinical profiles. Patients with Type I are significantly younger (mean age 65.5 years) compared to Type II (mean age 77 years) [274]. Younger patients (<76 years) more frequently present with DeBakey Type I, while older patients (≥76 years) more commonly present with Type II [16]D.
Emerging and Specialized Classifications
SVS/STS Classification
The 2020 Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) classification refines the Stanford system by emphasizing the primary entry tear location [15]D[19]D.
- SVS/STS Type A: Primary entry tear is in the ascending aorta or arch [15]D.
- SVS/STS Type B0: Dissection involves the ascending aorta (traditionally Stanford Type A) but the primary entry tear is located in the descending aorta (retrograde extension) [15]D[19]D. Studies indicate that SVS/STS Type A and B0 have different perioperative characteristics, though both require urgent repair when the ascending aorta is involved [19]D.
Penn Classification
The Penn classification is used to stratify mortality risk based on clinical presentation and the presence of ischemia [278]C:
- Class Non-A (N): No ischemia.
- Class A: Localized ischemia (e.g., stroke, visceral ischemia).
- Class B: Generalized malperfusion and shock.
- Class C: Both localized and generalized ischemia. This system has been validated to predict hospital mortality in both Stanford Type A and Type B dissections [278]C.
301 Classification for Type B
Proposed for Stanford Type B dissections undergoing thoracic endovascular aortic repair (TEVAR), the 301 classification categorizes based on the configuration of the true and false lumens relative to the vertebral bodies [23]D:
- Type B1 and B3: True/false lumens descend closely along the thoracic vertebral bodies.
- Type B2: Semi-spiral or spiral configuration, which may impact post-TEVAR aortic expansion [23]D.
Epidemiological and Clinical Variations
Epidemiological data from 1,343 cases show a male predominance (82.7%) with a mean age of 52.7 years; hypertension is the most common comorbidity (71.3%) [17]D. However, non-hypertensive patients also represent a significant cohort, and their clinical features post-TEVAR are a subject of ongoing study [10]. Ethnic disparities have also been noted; for instance, the indigenous Māori population in New Zealand shows distinct presentation patterns in acute aortic syndromes [22]D. Inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII), are increasingly recognized as predictors of in-hospital mortality [275].
| System | Category | Criteria |
|---|---|---|
| Stanford | Type A | Any involvement of the ascending aorta |
| Type B | Involvement of only the descending aorta | |
| DeBakey | Type I | Originates in ascending aorta, extends to arch/descending |
| Type II | Confined to the ascending aorta | |
| Type III | Originates in the descending aorta | |
| SVS/STS | Type A | Entry tear in the ascending aorta |
| Type B0 | Ascending involvement with entry tear in descending aorta | |
| Penn | Class N/A/B/C | Stratification by absence or presence of localized/generalized ischemia |
Etiology and Triggering Factors
- ▸Haploinsufficient FBN1 variants in Marfan syndrome carry a higher risk for pregnancy-related dissection than non-HI variants.
- ▸Fluoroquinolone use is associated with a significantly increased risk of aortic dissection within 30 days of exposure.
- ▸A baseline aortic diameter of ≥4.0 cm is a significant threshold for increased risk of aortic events.
- ▸Baseline descending thoracic aortic diameter (DTAD) is the strongest predictor of failure for conservative management in Type B dissection.
- ▸High glucose variability in the first 3 days post-surgery is a significant predictor of mortality in Type A dissection patients.
- ▸Sarcopenia and low grip strength are associated with worse 3-month survival post-aortic surgery.
The etiology of aortic dissection (AD) is multifactorial, involving a complex interplay between genetic predispositions, structural vascular degeneration, and acute pharmacological or physiological triggers. While hypertension remains a primary driver, recent evidence highlights specific genetic variants, anatomical markers, and pharmacological exposures that significantly elevate risk.
Genetic and Syndromic Predispositions
Genetic factors play a critical role, particularly in younger populations. Marfan syndrome (MFS), caused by mutations in the FBN1 gene, is a well-established risk factor. Recent data indicates that haploinsufficient (HI) FBN1 variants are associated with more severe aortic phenotypes compared to non-HI variants [281]. In pregnant women with MFS, these HI variants significantly increase the risk of pregnancy-related aortic dissection, particularly during the third trimester or within six months postpartum [281]. Notably, standard monitoring of aortic root diameter often fails to predict Stanford type B dissections in this population [281].
Autosomal dominant polycystic kidney disease (ADPKD) has also been epidemiologically linked to an increased incidence of both aortic dissection and aortic aneurysm, suggesting systemic connective tissue fragility beyond the renal system [285]. Furthermore, while bicuspid aortic valve (BAV) is associated with progressive aortic dilation, recent meta-analyses suggest that the risk of major aortic events after valve replacement may be comparable to those with tricuspid valves, provided longitudinal monitoring is maintained [288].
Pharmacological and Environmental Triggers
Fluoroquinolone (FQ) use has emerged as a significant pharmacological trigger for aortic events. Meta-analyses of large cohort studies demonstrate that FQ exposure is associated with a significantly elevated risk of de novo aortic aneurysm or dissection within 30 days of treatment [33][36]. This risk encompasses both Stanford Type A and Type B dissections, as well as aortic-specific mortality [36].
Anatomical and Morphological Risk Factors
Specific anatomical features are predictive of dissection and subsequent failure of conservative management:
- Aortic Diameter: In veterans, a baseline diameter of ≥4.0 cm is a critical threshold for increased aortic events and all-cause mortality [50]D. For uncomplicated Type B aortic dissection (uTBAD), the baseline descending thoracic aortic diameter (DTAD) is a primary driver of long-term failure in conservative medical management [291]C.
- Calcification: The presence of aortic and iliac calcifications, particularly when measured in a 5-segment model, serves as a predictor for aortic dissection and aneurysm rupture [38].
- Intimal Tear Location: In Stanford Type A dissection, the primary entry tear is most commonly located in the ascending aorta (56.2%), followed by the aortic arch (30.1%) and descending aorta (13.6%) [283]. The location of the tear significantly impacts long-term survival and surgical outcomes [283].
- Atherosclerotic Index of Plasma (AIP): High AIP levels are independently associated with long-term aortic-related adverse events (ARAEs) in patients undergoing thoracic endovascular aortic repair (TEVAR) [47]D.
Physiological and Perioperative Stressors
Acute physiological stressors can trigger or exacerbate the clinical course of dissection. Sarcopenia, characterized by reduced grip strength and muscle mass, is a prognostic marker for early mortality following surgical repair, as perioperative factors can accelerate functional decline [282]. In acute Type B dissection, factors such as younger age, higher BMI, and a completely patent false lumen are influential in the development of severe respiratory failure requiring respiratory assist devices [286]C.
For patients undergoing surgical repair (such as the modified Bentall procedure for Type A dissection), operative parameters including cardiopulmonary bypass (CPB) time and circulatory arrest duration are critical predictors of early mortality and neurologic complications [287]. Postoperative metabolic stability is also vital; high blood glucose variability within the first 3 days in the ICU is strongly associated with increased all-cause mortality [289]. Additionally, the need for emergency intubation prior to hospital admission in DeBakey Type I patients is a marker for poor early and long-term surgical outcomes [290].
| Tear Location | Frequency (%) | Impact |
|---|---|---|
| Ascending Aorta | 56.2% | Most common site; influences surgical approach |
| Aortic Arch | 30.1% | Associated with complex arch repair |
| Descending Aorta | 13.6% | Retrograde extension; impacts long-term survival |
Pathophysiology
- ▸Hypertension is the strongest risk factor for thoracic aortic dissection with a hazard ratio of 2.51.
- ▸The primary mechanism involves an intimal tear and the formation of a false lumen within the tunica media.
- ▸Medial neovascularization (MN) of the vasa vasorum is a proposed mechanism for dissection in hypertensive patients.
- ▸Aortic calcifications, particularly microcalcifications, are linked to the site of primary intimal tears by altering wall shear stress.
- ▸Target hemodynamics for acute management are SBP <120 mmHg and HR <60–80 bpm.
- ▸Advanced 4D flow MRI and CFD help identify high-risk hemodynamic biomarkers like wall shear stress and helical flow.
The pathophysiology of aortic dissection (AD) involves a complex interplay of mechanical, hemodynamic, and structural factors that culminate in the separation of the aortic wall layers. The process typically begins with an intimal tear, which allows blood to penetrate the tunica media, creating a false lumen that propagates along the vessel [32][283].
Hemodynamic Stress and Hypertension
Hypertension is the primary driver of aortic dissection, associated with a hazard ratio (HR) of 2.51 [32]. The mechanical forces acting on the aortic wall are characterized by the rate of ventricular contraction (dP/dt), heart rate, and absolute blood pressure [61]. Elevated systolic blood pressure (SBP) and heart rate (HR) increase the shear stress on the intima. Current management targets for acute Type B aortic dissection (TBAD) include an SBP <120 mmHg and HR <60–80 bpm to limit propagation [85]D. Sodium nitroprusside (SNP) is frequently utilized in these hypertensive emergencies due to its nitric oxide-mediated activation of the cGMP pathway, which induces balanced arterial and venous vasodilation, effectively reducing both preload and afterload [295].
Structural and Cellular Mechanisms
Structural integrity of the aorta is maintained by the extracellular matrix, particularly fibrillin-1. Mutations in the FBN1 gene, as seen in Marfan syndrome (MFS), lead to weakened aortic walls [299]D[300]D. Recent research suggests that medial neovascularization (MN)—an increased density of vasa vasorum within the outer third of the tunica media—may be a novel mechanism in hypertensive populations, as these vessels often coincide with the site of medial rupture [294]C. Additionally, aortic calcification distribution is significantly associated with the location of primary intimal tears (PITs). Computational fluid dynamics (CFD) and 18F-NaF PET/CT imaging have demonstrated that microcalcifications near PIT regions alter local wall shear stress (WSS), potentially predisposing the intima to tearing [297].
Tear Location and Remodeling
The location of the primary intimal tear significantly influences clinical outcomes. In Stanford Type A dissections, tears are most common in the ascending aorta (56.2%), followed by the aortic arch (30.1%) and descending aorta (13.6%) [283]. Localized aortic root dissection is a rare variant where the tear is confined to the root without distal propagation, often misdiagnosed as a congenital membrane [67]C. Iatrogenic dissections, occurring during hemodynamic procedures, differ from classic dissections in the angle of entry of the flap and the formation of the false lumen [68]C. Post-surgical remodeling can be heterogeneous; for instance, the use of hybrid prostheses like the AMDS can sometimes result in negative aortic remodeling requiring rescue via the frozen elephant trunk technique [69]C.
Advanced Biomechanical Assessment
Modern imaging techniques such as 4D flow MRI and CFD provide insights into hemodynamic heterogeneity. These tools measure biomarkers like helical flow patterns, wall shear stress (WSS), and systolic flow reversal ratios [71]D[292]C. In Marfan syndrome patients, the implantation of non-compliant synthetic grafts during aortic root surgery can alter biomechanics, leading to undampened flow and abnormal displacement in the proximal descending aorta, which may increase the risk of subsequent Type B dissection [300]D[301]D. Generative AI models (e.g., CE-MRA-FLOWnet) are now being developed to predict these complex hemodynamics directly from standard contrast-enhanced MRA images [293].
| Location | Frequency (%) | Clinical Impact |
|---|---|---|
| Ascending Aorta | 56.2% | Most common site for Stanford Type A |
| Aortic Arch | 30.1% | Requires complex arch repair |
| Descending Aorta | 13.6% | Retrograde propagation in Type A |
Clinical Features
- ▸Aortic dissection pain is typically maximal at onset and may migrate as the dissection propagates distally.
- ▸A systolic blood pressure differential >20 mmHg between arms or pulse deficits are high-yield physical exam findings for branch vessel involvement.
The clinical presentation of (AD) is notoriously heterogeneous, often earning it the moniker of the "great masquerader." A high index of clinical suspicion is required, as delayed diagnosis is a significant contributor to the high early mortality rate associated with acute aortic syndromes [92]. The presentation typically reflects the anatomical extent of the dissection, the involvement of branch vessels (malperfusion), and the presence of secondary complications such as or cardiac tamponade. ### Presenting Symptoms The hallmark of acute aortic dissection is the sudden onset of severe pain, often described as "tearing," "ripping," or "sharp." Unlike the crescendo pain of , AD pain is typically maximal at its inception [92].
Clinical Features and Variants
- ▸Acute aortic syndrome (AAS) includes classic aortic dissection, intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU).
- ▸Misdiagnosis is common when ischemic ECG changes lead to a suspicion of myocardial infarction.
- ▸The Aortic Dissection Detection Risk Score (ADD-RS) combined with D-dimer improves diagnostic sensitivity in the ED.
- ▸Direct Bypass Protocols (DBP) from non-aortic centers to high-volume centers improve Type A dissection outcomes.
- ▸In situ laser fenestration and 3D printing are emerging techniques for complex aortic arch pathologies.
- ▸Frozen elephant trunk (FET) procedures are effective even in high-risk patients with malperfusion or prior resuscitation.
Clinical Presentation and Diagnostic Challenges
Acute aortic syndrome (AAS) encompasses a spectrum of life-threatening conditions including classic aortic dissection (AD), intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU) [109][302]. The clinical presentation often mimics other cardiovascular emergencies, leading to significant diagnostic delays. A missed diagnosis of AAS is frequently associated with ischemic ECG changes and an initial clinical suspicion of myocardial infarction [127]D. In emergency department (ED) settings, the use of the Aortic Dissection Detection Risk Score (ADD-RS) in combination with D-dimer testing has been shown to improve patient selection for definitive imaging via computerized tomographic aortography (CTA) [123]D. While CTA remains the gold standard for diagnosis, clinical scores and biomarkers are essential for triaging patients, particularly those at low or intermediate risk [110][123]D.
Intramural Hematoma (IMH) and Penetrating Atherosclerotic Ulcer (PAU)
IMH and PAU are distinct variants of AAS with unique pathophysiological profiles. PAU is characterized by an ulcer that penetrates the internal elastic lamina into the aortic media, often progressing to IMH, dissection, or rupture [109]. International expert consensus recommends specific management for acute type B variants: for PAU and IMH, a modified Delphi process achieved >75% agreement on standardized treatment pathways [132]D. While IMH and classic AD share similar operative strategies, they exhibit distinct perioperative risk profiles; patients with acute type A IMH may have different hemostatic and operative requirements compared to those with classic AD [303]. Furthermore, preoperative factors such as exercise tolerance and nutritional-inflammatory markers are significant predictors of outcomes following thoracic endovascular aortic repair (TEVAR) for these pathologies [302].
Variants and Retrograde Extensions
Retrograde type A dissection and IMH represent high-acuity variants where the primary tear or hematoma extends proximally into the ascending aorta. While open surgical repair remains the traditional standard, TEVAR has emerged as a less invasive alternative for select cases, with meta-analyses comparing the two modalities to determine optimal survival and complication rates [113]. For patients diagnosed at non-aortic centers, the implementation of a Direct Bypass Protocol (DBP)—allowing patients to bypass the ED and proceed directly to surgical care at high-volume centers—has been shown to improve outcomes for Type A aortic dissection (TAAD) [121]D.
Advanced Endovascular and Surgical Techniques
Management of complex variants involving the aortic arch (Zones 0 and 1) has evolved with the use of physician-modified stent grafts (PMEGs) and laser-assisted techniques. In situ laser-assisted fenestration for left subclavian artery (LSA) revascularization during TEVAR is feasible in both elective and urgent settings, with the LLTEVAR trial reporting on its safety and efficacy for high-risk type B dissections [35][131]D. Additionally, 3D printing-assisted multi-fenestrated endovascular repair has demonstrated technical success in treating arch diseases, including AD and PAU [126]D. For extensive arch involvement, the frozen elephant trunk (FET) technique is increasingly utilized, even in high-risk patients who have undergone resuscitation or present with malperfusion syndrome, showing favorable outcomes in both high and low-volume centers [124]D[130]D.
Outcomes and Complications
Standardized institutional protocols for acute type B aortic dissection (TBAD) have been shown to reduce disease progression and the subsequent need for surgery [54]D. However, perioperative cardiac arrest remains a significant risk in emergency aortic surgeries compared to elective procedures [111]. Long-term survival and reintervention rates for TBAD vary based on whether the condition is classified as complicated (cTBAD), high-risk (hrTBAD), or uncomplicated (uTBAD) [128]D. Technical considerations, such as the use of barb-mediated active fixation in endografts, are under continuous evaluation to minimize migration and other device-related adverse events [122]D. For patients who are not candidates for open surgery, endovascular repair of the ascending aorta remains a "last resort" option with specific in-hospital and 3-year mortality risks [304]C.
| Variant | Key Feature | Primary Management Trend |
|---|---|---|
| Classic AD | Intimal tear with true/false lumen | Surgery (Type A) or OMT/TEVAR (Type B) |
| IMH | Hematoma within the aortic wall | Medical management or TEVAR/Surgery |
| PAU | Ulceration through internal lamina | TEVAR increasingly preferred for Type B |
| Retrograde Type A | Proximal extension from distal tear | Open surgery vs. emerging TEVAR options |
Differential Diagnosis
- ▸Aortic dissection often mimics acute myocardial infarction, particularly when coronary malperfusion is present [127][307].
- ▸Flat T waves on digital ECG (amplitude <0.1 mV) are associated with increased risk of aortic dissection [57].
- ▸Both aortic dissection and pulmonary embolism show a strong seasonal pattern, with an 18.6% decrease in AD cases during summer [144].
- ▸Kinesiophobia levels in AD patients are comparable to those in AMI and unstable angina patients [308].
- ▸Isolated left vertebral artery (ILVA) is a specific anatomical variant that increases stroke risk during ATAAD repair [310].
- ▸Peripheral leukocyte mRNA expression is being investigated as a potential novel biomarker to differentiate ATAAD from AMI [151].
The differential diagnosis of aortic dissection (AD) is broad due to its presentation with acute chest or back pain, often mimicking more common cardiovascular emergencies. Accurate differentiation is critical, as misdiagnosis is associated with ischemic electrocardiographic (ECG) changes and an initial suspicion of acute myocardial infarction (AMI) [127]D.
Acute Coronary Syndromes (ACS)
Acute myocardial infarction (AMI) and unstable angina (UA) are the most frequent mimics of aortic dissection. Patients with AD often present with high levels of kinesiophobia (fear of movement), similar to those with AMI and UA [308]. A critical diagnostic challenge occurs when AD causes coronary malperfusion (CM), which occurs in a subset of acute type A aortic dissection (ATAAD) cases [307]. CM can lead to ST-segment changes on ECG, potentially leading clinicians to prioritize coronary intervention over aortic repair [138]. While preoperative coronary angiography is sometimes performed to evaluate CM, evidence suggests it may not significantly improve in-hospital mortality compared to direct aortic repair [138]. Furthermore, digital ECG detection of flat T waves (amplitude <0.1 mV and T/R ratio <10%) has been identified as a predictor for cardiovascular events, including aortic dissection [57]D.
Pulmonary Embolism (PE)
Pulmonary embolism is a major consideration in the differential of acute chest pain and syncope. Both AD and PE exhibit seasonal variation, with peaks in winter and troughs in summer; AD admissions decrease by 18.6% during summer months [144]D. In patients presenting with syncope, the diagnostic utility of biomarkers like troponin and BNP, or imaging like transthoracic echocardiography (TTE), remains under investigation for differentiating PE from aortic causes [135].
Other Aortic and Vascular Pathologies
- Thoracic Aortic Aneurysm (TAA): Aneurysms may present with similar pain if they are rapidly expanding or leaking [149]D.
- Intramural Hematoma (IMH) and Penetrating Aortic Ulcer (PAU): These are part of the acute aortic syndrome spectrum and can be indistinguishable from AD without advanced imaging [309]C.
- Acute Limb Ischemia: While often a primary vascular event, it can be a secondary complication of distal aortic expansion or malperfusion following TEVAR [133].
Neurological and Systemic Mimics
- Acute Ischemic Stroke (AIS): Aortic dissection can present as a stroke if the dissection involves the carotid or vertebral arteries. Patients with an isolated left vertebral artery (ILVA) are at a higher risk for perioperative brain damage during ATAAD repair [310]. Whole-body CT protocols are increasingly proposed for suspected AIS patients to exclude underlying aortic causes [311]C.
- Vasculitis: Systemic conditions such as ANCA-associated vasculitis (AAV) can cause rapidly progressive coronary and aortic lesions, mimicking the presentation of ATAAD even in normolipidemic patients [140]C.
Diagnostic Pitfalls and Liability
Misdiagnosis of acute aortic syndrome remains a significant clinical risk, often occurring when clinicians focus on more common diagnoses like ACS or PE due to overlapping symptoms and initial ECG findings [127]D. In the field of cardiology, complex diagnostics and the emergency nature of these conditions contribute to civil medical liability claims [306].
| Condition | Key Differentiating Features | Evidence Level |
|---|---|---|
| Acute Myocardial Infarction | Ischemic ECG changes; may coexist with AD if coronary malperfusion occurs [138][307]. | 3b |
| Pulmonary Embolism | Seasonal winter peak; associated with syncope and right heart strain [144]D[135]. | 3b |
| Acute Ischemic Stroke | May be the primary presentation of AD; requires whole-body CT for exclusion [311]C. | 4 |
| ANCA-associated Vasculitis | Rapidly progressive coronary/aortic lesions in normolipidemic patients [140]C. | 4 |
| Aortic Aneurysm/PAU | Identified via CT; part of the acute aortic syndrome spectrum [309]C. | 4 |
Management of Aortic Dissection
- ▸Anti-impulse therapy must target a heart rate of **≤60 bpm** and SBP of **100-120 mmHg** to prevent dissection propagation [61].
- ▸Stanford Type A dissection requires emergent surgical repair, ideally facilitated by a Direct Bypass Protocol to minimize delays [121].
The of acute aortic dissection (AD) is a clinical exigency requiring simultaneous stabilization and definitive intervention. The primary goal is to limit the propagation of the dissection by reducing the shear stress on the aortic wall, followed by anatomical repair based on the Stanford classification [61][121]D. ### Step 1: Initial Assessment and Severity Classification Immediate management begins with rapid classification into Stanford Type A (involving the ascending aorta) or Type B (involving only the descending aorta).
Supportive Care and Complication Management
- ▸Early prone positioning (within 48 hours) reduces mechanical ventilation duration in post-ATAAD ARDS.
- ▸Postoperative glucose variability over the first 3 days is a significant predictor of ICU mortality.
- ▸Sarcopenia and reduced grip strength are associated with poor 3-month survival outcomes.
- ▸VA-ECMO for postcardiotomy shock after ATAAD repair carries a high in-hospital mortality rate of 72.4%.
- ▸Methylguanidine is a candidate biomarker for the early detection of mesenteric malperfusion syndrome.
- ▸Autograft dissection after the Ross procedure frequently occurs at root diameters ≤ 55 mm.
Respiratory and Neurological Management
Postoperative respiratory failure is a significant concern following acute type A aortic dissection (ATAAD) repair. In patients developing moderate-to-severe acute respiratory distress syndrome (MS-ARDS), early prone positioning (≤ 48 hours) has been shown to be safe, feasible, and effective in shortening the duration of mechanical ventilation [313]. Preoperative status also dictates outcomes; emergency intubation performed prior to hospital admission for DeBakey Type I dissection is associated with higher early and long-term surgical mortality [290]. Neurological complications, particularly postoperative delirium (POD), are common; risk prediction models utilizing factors such as age, surgical duration, and inflammatory markers can help identify high-risk patients [319].
Malperfusion Syndrome (MPS) and Organ Protection
Malperfusion syndrome remains a highly lethal complication of acute aortic dissection (AAD), necessitating stratified treatment strategies based on the specific ischemic organs and underlying mechanisms [318]. For stable ATAAD patients with MPS but without aortic rupture or tamponade, a strategy of endovascular reperfusion followed by delayed open aortic repair has been utilized, though hospital mortality remains high at 37.2% compared to those without MPS [184]D. Mesenteric malperfusion (ATAAD-MMPS) is particularly challenging to diagnose; recent metabolomic profiling suggests methylguanidine may serve as a potential early diagnostic biomarker for this condition [317]C.
Metabolic and Nutritional Considerations
Metabolic stability in the intensive care unit (ICU) is a critical determinant of survival. High 3-day postoperative blood glucose variability (measured by the coefficient of variation) is significantly associated with increased all-cause mortality in survivors of TAAD repair [289]. Furthermore, the presence of sarcopenia—characterized by reduced grip strength and metabolic reserves—serves as a potent prognostic marker, correlating with increased early mortality and a higher risk of complications within 3 months postoperatively [282].
Renal and Hemodynamic Support
Acute kidney injury (AKI) is a frequent complication following dissection repair. Predictive models integrating clinical features with the dynamic neutrophil-to-lymphocyte ratio (ΔNLR) have been validated to identify patients at risk for postoperative AKI [315]. In cases of refractory postcardiotomy cardiogenic shock following ATAAD repair, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may be employed. While weaning success is approximately 48.3%, overall in-hospital mortality remains high at 72.4%, often complicated by AKI requiring continuous renal replacement therapy [158].
Surgical and Endovascular Complications
Long-term management must address potential failures of the initial repair. Proximal anastomotic new entry tears (PANE) can occur following ATAAD surgery, presenting as true-false lumen communication or pseudoaneurysms at the anastomosis site [284]. For residual arch dissections, arch branched endovascular aortic repair (a-BEVAR) is emerging as a less invasive alternative to redo open arch repair [171]D. When performing thoracic endovascular aortic repair (TEVAR), preservation of the left subclavian artery (LSA) using dedicated branched or fenestrated endografts is feasible and effective [159].
In patients undergoing the Ross procedure, rare but catastrophic autograft (neoaortic) dissection or rupture can occur, often years later (median 10 years); 60% of these events occur when the autograft root diameter is ≤ 55 mm, particularly in patients with native bicuspid aortic valve (BAV) morphology [314]C. For patients with BAV undergoing valve interventions, longitudinal monitoring is essential as they exhibit different aortic growth rates and risks of major aortic events compared to tricuspid aortic valve (TAV) patients [288].
| Complication/Scenario | Key Finding | Evidence Level |
|---|---|---|
| Malperfusion Syndrome (MPS) | 37.2% hospital mortality with delayed repair strategy | 3b [184]D |
| VA-ECMO Support | 48.3% weaning success; 72.4% in-hospital mortality | 2a [158] |
| Ross Procedure Autograft | Median 10-year interval to dissection/rupture | 4 [314]C |
| MS-ARDS (Post-ATAAD) | Early prone positioning (≤ 48h) is safe and effective | 2b [313] |
| Bentall Procedure | Operative parameters influence early mortality/neurologic outcomes | 2a [287] |
Landmark Trials and Key Evidence
- ▸IRAD data shows a temporal increase in hypertension prevalence (80.4%) among aortic dissection patients.
- ▸Surgical management of TAAD has shifted toward valve-sparing procedures (26.7%) and biologic valve use (52.0%).
- ▸Direct-to-operating room (DOR) protocols can reduce time to intervention by 82 minutes.
- ▸TEVAR is now recommended for high-risk uncomplicated TBAD, including those with aortic diameters >40 mm.
- ▸Women with AAD are generally older and experience longer diagnostic delays than men.
- ▸Iatrogenic aortic dissection accounts for 2.5% of cases, often linked to cardiac surgery or catheterization.
- ▸Preoperative MI occurs in 10.8% of TAAD patients and significantly worsens prognosis.
The International Registry of Acute Aortic Dissection (IRAD) Insights
Over the past 25 years, the International Registry of Acute Aortic Dissection (IRAD) has provided the most comprehensive longitudinal data on acute aortic dissection (AAD), encompassing over 11,000 patients across 61 centers [198]D. Analysis of time-based tertiles from 1996 to 2022 reveals significant shifts in patient profiles and management. The prevalence of hypertension among AAD patients has increased from 77.8% to 80.4%, while smoking rates have declined [198]D. Despite diagnostic and therapeutic advancements, early mortality remains a critical concern. Contemporary data indicates that while the historical '1% to 2% per hour' mortality rate for Type A Acute Aortic Dissection (TAAAD) is still cited, modern surgical interventions have significantly altered the survival curve for those reaching specialized centers [209]D.
Type A Aortic Dissection (TAAD): Surgical Evolution and Outcomes
Management of TAAD has transitioned toward more complex and tailored surgical strategies. Between 1996 and 2016, the frequency of valve-sparing procedures increased from 3.9% to 26.7% [323]C. There has also been a notable shift in valve selection: the use of biologic valves rose from 35.6% to 52.0%, while mechanical valve utilization decreased from 57.6% to 45.4% [323]C.
Cannulation strategies remain a point of debate, though IRAD data comparing axillary versus femoral arterial cannulation in 2,145 patients found no definitive 'gold standard,' with both methods showing similar proportions of patients under 70 years and comparable complication profiles [106]D. However, the timing of intervention is paramount. The implementation of direct-to-operating room (DOR) transfer programs has been shown to reduce the time from hospital arrival to incision by 82 minutes (1.37 h vs 1.93 h), significantly expediting emergency care [204]D.
Mortality prediction in TAAD has been refined through the validation of four major scoring systems (including the German Registry of Acute Aortic Dissection score) in a multicenter cohort of 1,895 patients, showing an average 30-day mortality of 21.7% and in-hospital mortality of 22.5% [200]D. Specific high-risk subgroups include patients with preoperative myocardial infarction (MI), occurring in 10.8% of TAAD cases, which is associated with higher mortality due to coronary malperfusion or hemodynamic collapse [145]D. Furthermore, patients aged ≥70 years presenting with a cerebrovascular accident (CVA) face an in-hospital mortality rate of 32.7%, compared to 21.7% in those without CVA [216]D.
Type B Aortic Dissection (TBAD): Endovascular Shift
The management of Type B Aortic Dissection (TBAD) has seen a paradigm shift from purely medical management to selective thoracic endovascular aortic repair (TEVAR) [320]. Current guidelines recommend TEVAR for high-risk, uncomplicated cases, defined by an aortic diameter >40 mm, large entry tears, or persistent pain [320]. In complicated TBAD, such as those with mesenteric malperfusion (MesMP), in-hospital mortality remains high, necessitating rapid endovascular or surgical revascularization [194].
Genetic and familial factors also play a distinct role in TBAD. Nonsyndromic familial TBAD (FTBAD) exhibits clinical profiles and outcomes distinct from both sporadic cases and Marfan syndrome (MFS)-related dissections, suggesting unique underlying aortic vulnerability [321].
Special Populations and Etiologies
- Sex-Related Differences: Women comprise approximately one-third of AAD cases (34.4% of TAAD; 34.5% of TBAD) [48]D. Women tend to be older at presentation and often experience longer delays from symptom onset to hospital admission compared to men [48]D.
- Pregnancy-Related Dissection: Aortic dissection during pregnancy or within 12 weeks postpartum is often associated with underlying, previously unrecognized aortopathy [322].
- Iatrogenic Dissection (iAD): Accounting for 2.5% of all AADs, iAD is primarily caused by cardiac surgery (51% of Type A) or catheter-induced trauma (47% of Type B) [196]D. Patients with iAD are typically older with more extensive atherosclerosis than those with spontaneous dissections [196]D.
- Octogenarians: While the incidence of TAAD in patients aged ≥80 is increasing, emergency surgery in this group shows mixed results; some studies suggest no significant mortality benefit over medical management, while others emphasize the importance of functional quality-of-life outcomes [324].
Global Perspectives and Long-term Care
There is a significant geographic disparity in AAD research; despite representing 17% of the global population, Africa accounts for only 1% of the available literature, highlighting the need for regional registries [195]. For survivors, long-term outcomes are heavily dependent on medication adherence. While beta-blockers improve survival in both Type A and Type B survivors, calcium channel blockers have shown selective survival benefits primarily in Type B patients [326]C.
| Procedure/Component | 1996-2003 (T1) | 2011-2016 (T3) | P-value (Trend) |
|---|---|---|---|
| Valve Sparing Procedures | 3.9% | 26.7% | < 0.001 |
| Biologic Valve Use | 35.6% | 52.0% | 0.009 |
| Mechanical Valve Use | 57.6% | 45.4% | 0.027 |
| Subgroup | Mortality/Outcome Rate | Reference |
|---|---|---|
| TAAD with Preoperative MI | Increased Mortality | [145]D |
| TAAD with CVA (Age ≥70) | 32.7% In-hospital Mortality | [216]D |
| TAAD Overall (30-day) | 21.7% | [200]D |
| Iatrogenic Dissection (iAD) | 2.5% of total AAD | [196]D |
Special Populations
- ▸Pregnancy-related aortic dissection risk peaks in the third trimester and postpartum period, with a maternal mortality rate of approximately 10.4%.
- ▸In Turner Syndrome, an Aortic Size Index (ASI) >2.5 cm/m² is an absolute contraindication for pregnancy due to the high risk of rupture.
Aortic dissection (AD) requires significant modification in specific cohorts where physiological stressors, genetic predispositions, or anatomical variations alter the risk-benefit ratio of standard interventions. High-risk groups include pregnant individuals, pediatric patients with heritable thoracic aortic diseases (HTAD), and the elderly, who exhibit distinct vascular aging patterns [226]D[235]D[239]D. ### Pregnancy and Postpartum Pregnancy-related acute AD is a lethal complication that typically occurs in the third trimester (50%–60%) or the postpartum period (30%–50%) [229]C.
Guidelines and Resources
- ▸The 2022 ACC/AHA guidelines emphasize the role of multidisciplinary 'Aortic Teams' and lower the threshold for genetic testing to all patients under age 60 with thoracic aortic disease.
- ▸Contrast-enhanced CT remains the gold standard for diagnosis, with a critical focus on identifying malperfusion and false lumen status to guide urgent surgical or endovascular intervention.
Clinical of and related acute aortic syndromes (AAS) is governed by evidence-based guidelines that emphasize rapid diagnosis, multidisciplinary care, and longitudinal surveillance. The 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease represents the most comprehensive update, consolidating recommendations for both thoracic and abdominal pathologies into a single framework [251][252]. These guidelines advocate for the formation of multidisciplinary "Aortic Teams" to optimize outcomes in complex cases, particularly when determining the timing of surgical intervention for asymptomatic aneurysms or chronic dissections [253].
References
- [1]
Bin L, Fei J, Zhao L et al.. “Comparative effectiveness and safety of open triple-branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta-analysis.” Journal of cardiac surgery (2022). PMID: 36352782 ↗
L2aSR_OBSCited in: Definition, Synonyms, and Classification - [2]
Yamashita Y, Sicouri S, Dokollari A et al.. “Double arterial vs. single axillary cannulation in acute type A aortic dissections: a meta-analysis.” Future cardiology (2024). PMID: 38963122 ↗
L2aSR_OBSCited in: Definition, Synonyms, and Classification - [3]
Yamashita Y, Sicouri S, Kjelstrom S et al.. “Direct aortic cannulation versus femoral arterial cannulation for early outcomes in acute type A aortic dissection: A study-level meta-analysis.” Perfusion (2025). PMID: 38537032 ↗
L2aSR_OBSCited in: Definition, Synonyms, and Classification - [4]
Yamashita Y, Sicouri S, Dokollari A et al.. “Aortic versus axillary cannulation in acute type A aortic dissection repair: A meta-analysis.” Asian cardiovascular & thoracic annals (2024). PMID: 38343086 ↗
L2aSR_OBSCited in: Definition, Synonyms, and Classification - [5]
Guglielmi V, Groeneveld NS, Posthuma L et al.. “Aortic dissection masquerading as a code stroke: A single-centre cohort study.” European stroke journal (2020). PMID: 32232170 ↗
L2bCOHORTCited in: Definition, Synonyms, and Classification - [6]
Modares M, Hanneman K, Ouzounian M et al.. “Computed Tomography Angiography Assessment of Acute Aortic Syndromes: Classification, Differentiating Imaging Features, and Imaging Interpretation Pitfalls.” Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes (2022). PMID: 33874779 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [7]
Zhu Y, Lingala B, Baiocchi M et al.. “Type A Aortic Dissection-Experience Over 5 Decades: JACC Historical Breakthroughs in Perspective.” Journal of the American College of Cardiology (2020). PMID: 33004136 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [8]
Saremi F, Hassani C, Lin LM et al.. “Image Predictors of Treatment Outcome after Thoracic Aortic Dissection Repair.” Radiographics : a review publication of the Radiological Society of North America, Inc (2018). PMID: 30312138 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [9]
Gutschow SE, Walker CM, Martínez-Jiménez S et al.. “Emerging Concepts in Intramural Hematoma Imaging.” Radiographics : a review publication of the Radiological Society of North America, Inc (2016). PMID: 27163587 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [10]
Li S, Liu X, Yang J et al.. “Clinical features and survival analysis of non-hypertensive aortic dissection patients post-thoracic endovascular aortic repair: a 10-year retrospective study.” Journal of thoracic disease (2024). PMID: 39678834 ↗
L2bCOHORTCited in: Definition, Synonyms, and Classification - [11]
Uriu Y, Kuriyama A. “Malperfusion-associated transient monoplegia as an initial manifestation of aortic dissection.” The American journal of emergency medicine (2021). PMID: 33036846 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [12]
Ramesh P, Al-Zubaidi FI, Abdelghaffar M et al.. “TEM Classification of Aortic Dissection-The Evolving Scoring System: A Literature Review.” Heart, lung & circulation (2024). PMID: 38143192 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [13]
Gao Y, Li D, Cao Y et al.. “Prognostic value of serum albumin for patients with acute aortic dissection: A retrospective cohort study.” Medicine (2019). PMID: 30732220 ↗
L2bCOHORTCited in: Definition, Synonyms, and Classification - [14]
Abarca Rozas BA, Schwarze Fieldhouse MW, Contreras Bertolo RI et al.. “Atypical presentation and late diagnosis of acute aortic dissection without timely surgical treatment: case report and literature review.” Medwave (2018). PMID: 30240389 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [15]
Wu Z, Yuan Y, Chai C et al.. “Impact of the society for vascular surgery/society of thoracic surgeons classification on prognosis and therapeutic strategies in acute Stanford type A aortic dissection.” Frontiers in cardiovascular medicine (2026). PMID: 41953671 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [16]
Shirakura K, Ushioda R, Kunioka S et al.. “Association of Stanford, DeBakey classification and false-lumen blood flow with age of onset in acute aortic dissection.” Frontiers in cardiovascular medicine (2026). PMID: 41859548 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [17]
Xu Y, Huang C, Huang C et al.. “Analysis of epidemiological characteristics and prognosis based on 1,343 cases of aortic dissection from a regional single center.” Frontiers in cardiovascular medicine (2026). PMID: 41725939 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [18]
Canalejo-Codina F, López-Lluva MT, Rumoroso JR et al.. “Epidemiology, treatment, and data management trends in aortic dissection and related syndromes: Insights and limitations from the RAE-CMBD in Spain (2016-2021).” Progress in cardiovascular diseases (2025). PMID: 41448445 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [19]
Ikeno Y, Tanaka A, Troncone MJ et al.. “Impact of new classification from the Society for Vascular Surgery and Society of Thoracic Surgeons on acute Stanford type A aortic dissection.” Journal of vascular surgery (2025). PMID: 40692091 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [20]
Zhang J, Han L, Liu H et al.. “Metabolomic analysis reveals the metabolic disturbance in aortic dissection: Subtype difference and accurate diagnosis.” Nutrition, metabolism, and cardiovascular diseases : NMCD (2023). PMID: 37263915 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [21]
Huang LT, Tsai YS, Liou CF et al.. “Automated Stanford classification of aortic dissection using a 2-step hierarchical neural network at computed tomography angiography.” European radiology (2022). PMID: 34854930 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [22]
Xu W, Mani K, Khashram M. “Ethnic differences in incidence and outcomes of acute aortic syndromes in the Midland region of New Zealand.” Journal of vascular surgery (2022). PMID: 34506891 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [23]
Ge YY, Rong D, Ge XH et al.. “The 301 Classification: A Proposed Modification to the Stanford Type B Aortic Dissection Classification for Thoracic Endovascular Aortic Repair Prognostication.” Mayo Clinic proceedings (2020). PMID: 32622443 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [24]
Pan E, Gudbjartsson T, Ahlsson A et al.. “Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry.” The Journal of thoracic and cardiovascular surgery (2018). PMID: 29753501 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [25]
Platon A, Bernard S, Perrin N et al.. “Type A aortic dissection: Are there CT signs suggestive of valvular involvement?” European journal of radiology (2016). PMID: 27776642 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [26]
Xue J, Ni Y, He J et al.. “A case of twin pregnancy with "precious fetuses" complicated by DeBakey type I aortic dissection.” Journal of cardiothoracic surgery (2025). PMID: 41126334 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [27]
Varela-Jaramillo S, Taub-Krivoy A, Gómez-Gutiérrez MA et al.. “Neurological Manifestations of Aortic Dissection: A Scoping Review.” Journal of acute medicine (2024). PMID: 39624147 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [28]
Gao ZC, Wang Y, Li GS et al.. “[Risk factors for adverse prognosis in acute aortic syndrome: a single-center retrospective cohort study].” Zhonghua xin xue guan bing za zhi (2025). PMID: 39965848 ↗
L2bCOHORTCited in: Definition, Synonyms, and Classification - [29]
Nakajima T, Shibata T, Mukawa K et al.. “Treatment Strategies for Acute Aortic Dissection With Malperfusion: A Retrospective Study.” Cureus (2024). PMID: 39219975 ↗
L2bCOHORTCited in: Definition, Synonyms, and Classification - [30]
MacKerricher W, Klein RR, Winston DC. “Association of Antemortem Central Nervous System Symptoms and Location of Aortic Dissections; A Retrospective Study from 2001-2014.” Academic forensic pathology (2016). PMID: 31239925 ↗
L2bCOHORTCited in: Definition, Synonyms, and Classification - [31]
Han Z, Li B, Liu J. “Predictive value of machine learning for mortality risk in aortic dissection: a systematic review and meta-analysis.” International journal of medical informatics (2026). PMID: 41539126 ↗
L2aSR_OBSCited in: Etiology and Triggering Factors - [32]
Sharma S, Seth J, Rabkin SW. “Hypertension in Thoracic Aortic Dissection: A Meta-Analysis-Based Consideration in the Choice of Antihypertensive Agents.” American journal of hypertension (2026). PMID: 41206434 ↗
L2aSR_OBSCited in: Etiology and Triggering Factors, Pathophysiology, History and Physical Examination - [33]
Chen Q, Jiang Y, Shen Y et al.. “Risk of aortic aneurysm/aortic dissection associated with fluoroquinolones use: A meta-analysis of cohort studies.” Vascular (2026). PMID: 41678806 ↗
L2aSR_OBSCited in: Etiology and Triggering Factors - [34]
Squizzato F, Bilato MJ, Menegolo M et al.. “A Systematic Review and Meta-Analysis on the Outcomes of Distal Aortic Interventions for Residual Aortic Dissection.” Annals of vascular surgery (2026). PMID: 41106673 ↗
L2aSR_OBSCited in: Etiology and Triggering Factors - [35]
Peng Z, Liang S, Zhang R et al.. “Left Subclavian Artery Revascularization With In Situ Laser Fenestration During Thoracic Endovascular Aortic Repair for Acute Complicated or High-Risk Type B Aortic Dissection: Results of the LLTEVAR Trial.” Journal of the American Heart Association (2025). PMID: 41368828 ↗
L2bTRIAL_NONRANDOMCited in: Etiology and Triggering Factors, Clinical Features and Variants, Differential Diagnosis, Supportive Care and Complication Management - [36]
Wu ZY, Yang Y, Li ZL et al.. “Effects of Fluoroquinolones on Aortic Aneurysm or Dissection Processes: A Systematic Review and Meta-Analysis.” Reviews in cardiovascular medicine (2026). PMID: 41923717 ↗
L2aSR_OBSCited in: Etiology and Triggering Factors - [37]
Kaewboonlert N, Pongsuwan N, Chatkaewpaisal C et al.. “Survival outcomes of hybrid versus total arch replacement in type A aortic dissection: A meta-analysis of reconstructed individual participant data.” Asian cardiovascular & thoracic annals (2026). PMID: 41236863 ↗
L2aSR_OBSCited in: Etiology and Triggering Factors, Supportive Care and Complication Management - [38]
Petersen CS, Karon Z, Obel LM et al.. “Aortic and Iliac Calcifications as Predictors of Aortic Dissection, Aneurysm Rupture, and Peripheral Vascular Disease: A Prospective Cohort Study from the DANCAVAS Trials.” Circulation (2026). PMID: 41766556 ↗
L2bCOHORTCited in: Etiology and Triggering Factors - [39]
Shao Z, Lu Z, Duan W et al.. “Insulin resistance indicators in aortic disease: A large cohort study.” Clinical and translational medicine (2026). PMID: 41499559 ↗
L2bCOHORTCited in: Etiology and Triggering Factors - [40]
Bashir M, Jubouri M, Surkhi AO et al.. “From Equipoise to Evidence: Pre-Trial Setup of the European Uncomplicated Type B Aortic Repair Clinical Trial.” Annals of vascular surgery (2026). PMID: 41421577 ↗
L2bTRIAL_NONRANDOMCited in: Etiology and Triggering Factors, Supportive Care and Complication Management - [41]
Yan M, Wang K, Liu S et al.. “Factors associated with device-associated health care-associated infections after cardiac surgery: a matched cohort study.” PeerJ (2026). PMID: 41978887 ↗
L2bCOHORTCited in: Etiology and Triggering Factors - [42]
Imbriani M, Marchesini D, Piras GN et al.. “Mucoid extracellular matrix accumulation as a histopathological marker of aortic fragility: Two autopsy cases and a literature review.” Legal medicine (Tokyo, Japan) (2026). PMID: 41525745 ↗
L4CASE_REPORTCited in: Etiology and Triggering Factors - [43]
Pruna-Guillen R, Rojanathagoon T, Oo A et al.. “Impact of an On-Call Specialist Aortic Rota Implementation in Acute Type a Aortic Dissection on Outcomes and Repair Complexity: A Retrospective Cohort Study.” Interdisciplinary cardiovascular and thoracic surgery (2025). PMID: 41148058 ↗
L2bCOHORTCited in: Etiology and Triggering Factors, Supportive Care and Complication Management - [44]
Li C, Liu C. “Multimodal imaging of acquired aortic diseases: clinical efficacy, comparative analysis, and future perspectives.” The international journal of cardiovascular imaging (2026). PMID: 41549183 ↗
L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors, Clinical Features and Variants - [45]
Pan C, Ning S, Zhou Y et al.. “Influencing Factors of Postoperative Mechanical Ventilation Weaning Outcomes in Acute Stanford Type A Aortic Dissection: A Single-Center Retrospective Study.” British journal of hospital medicine (London, England : 2005) (2025). PMID: 41134180 ↗
L2bCOHORTCited in: Etiology and Triggering Factors, Supportive Care and Complication Management - [46]
Ram E, Lau C, Gregg A et al.. “Comparative Analysis of Risk Profile and Treatment Outcomes in Patients with Thoracoabdominal Aortic Aneurysm: Chronic Dissection Versus Degenerative Disease.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2026). PMID: 41904662 ↗
L5OTHERCited in: Etiology and Triggering Factors, Supportive Care and Complication Management - [47]
Li S, Li W, Zhang J et al.. “Association between atherosclerotic index of plasma and long-term aortic-related adverse events in type B aortic dissection patients undergoing thoracic endovascular aortic repair.” Cardiovascular diabetology (2026). PMID: 41787449 ↗
L5OTHERCited in: Etiology and Triggering Factors, Management - [48]
Jackson E, Carbone A, Shalhub S et al.. “Sex-Related Differences in Clinical Profile, Management, and Outcomes of Patients With Type A and B Acute Aortic Dissection: Observations From IRAD.” Journal of the American Heart Association (2026). PMID: 41744110 ↗
L5OTHERCited in: Etiology and Triggering Factors, Management, Landmark Trials and Key Evidence - [49]
Dell'Aquila AM, Georgevici AI, Wisniewski K et al.. “Risk Profile and Outcomes of Patients Requiring Coronary Revascularization as Concomitant Procedure to Repair of Type A Aortic Dissection.” The Annals of thoracic surgery (2026). PMID: 41563923 ↗
L5OTHERCited in: Etiology and Triggering Factors, Pathophysiology - [50]
Gomez A, Carroway W, Tu S et al.. “Ascending Thoracic Aortic Aneurysms in a Veterans Affairs Health System: Longitudinal Outcomes and Risk Factors.” Journal of the American Heart Association (2026). PMID: 41532501 ↗
L5OTHERCited in: Etiology and Triggering Factors - [51]
Tang C, Wang T, Diao H et al.. “Development and validation of a predictive model for postoperative acute respiratory distress syndrome in patients with type A aortic dissection based on the 2023 updated definition.” Respiratory research (2025). PMID: 41388298 ↗
L5OTHERCited in: Etiology and Triggering Factors, Supportive Care and Complication Management - [52]
Abusafia M, Jadam S, Kalahasti V et al.. “Sex-Based Differences in Long-Term Outcomes of Patients With Ascending Aortic Dilation.” Journal of the American Heart Association (2025). PMID: 41334743 ↗
L5OTHERCited in: Etiology and Triggering Factors - [53]
Maznyczka A, Gill C, Norman S et al.. “Outcomes of Non-Anesthetist Led Conscious Sedation for 2000 Transcatheter Aortic Valve Implantations.” Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2026). PMID: 41332125 ↗
L5OTHERCited in: Etiology and Triggering Factors, Supportive Care and Complication Management - [54]
Gober LM, Telma K, Richmond E et al.. “Protocolized management of acute type B aortic dissections reduces disease progression and need for surgery.” Journal of vascular surgery (2026). PMID: 41317972 ↗
L5OTHERCited in: Etiology and Triggering Factors, Clinical Features and Variants - [55]
Frumkin D, Nersesian G, Spethmann S et al.. “Acute type A aortic dissection following TAVI.” International journal of cardiology (2026). PMID: 41276188 ↗
L5OTHERCited in: Etiology and Triggering Factors, Supportive Care and Complication Management - [56]
Yokota A, Kabutoya T, Hoshide S et al.. “Digital electrocardiogram-measured P-wave duration and hypertensive heart disease are associated with cardiovascular events in patients with cardiovascular risks.” Hypertension research : official journal of the Japanese Society of Hypertension (2026). PMID: 41272126 ↗
L5OTHERCited in: Etiology and Triggering Factors - [57]
Kabutoya T, Hoshide S, Kario K. “Digital ECG detection of flat T waves predicts cardiovascular events in high-risk patients: the Coupling Study.” Hypertension research : official journal of the Japanese Society of Hypertension (2026). PMID: 41272124 ↗
L5OTHERCited in: Etiology and Triggering Factors, Differential Diagnosis - [58]
Chamseddine H, Halabi M, Hamdan H et al.. “The impact of intervention timing, etiology, and revascularization strategy on acute mesenteric ischemia outcomes.” Journal of vascular surgery (2026). PMID: 41242625 ↗
L5OTHERCited in: Etiology and Triggering Factors - [59]
Nadel J, Suinesiaputra A, Paratz ED et al.. “Site-Specific Analysis of Thoracic Aortic Aneurysm and Cardiovascular Mortality: Insights From the National Echo Database Australia.” Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography (2026). PMID: 41242620 ↗
L5OTHERCited in: Etiology and Triggering Factors - [60]
Kletzer J, van Kampen A, Peterss S et al.. “Weathering the Aorta: The Impact of Environmental Factors on Acute Aortic Dissection.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2025). PMID: 41223150 ↗
L5OTHERCited in: Etiology and Triggering Factors - [61]
Liu G, Wang D, Yang Y et al.. “Efficacy and Safety of preoperative Controlling Heart Rate in Patients with Acute Type A Aortic Dissection (ESCORT): protocol for a randomised controlled trial.” BMJ open (2026). PMID: 41962972 ↗
L2bTRIAL_NONRANDOMCited in: Pathophysiology, History and Physical Examination, Management - [62]
Chen X, Xie W, Li W et al.. “Cerebral Oximetry Index-Guided Blood Pressure Management During Cardiopulmonary Bypass Reduces Postoperative Delirium in Patients with Acute Type A Aortic Dissection.” Journal of cardiothoracic and vascular anesthesia (2025). PMID: 39855957 ↗
L1bRCTCited in: Pathophysiology, History and Physical Examination - [63]
Naito N, Takagi H. “Thoracic endovascular aortic repair for retrograde type a intramural hematoma or aortic dissection with intimal disruption in the descending aorta: Systematic review and meta-analysis.” Perfusion (2025). PMID: 39977541 ↗
L2aSR_OBSCited in: Pathophysiology - [64]
Hochberg CH, Yan L, Card ME et al.. “Outcomes of patients with hypertensive emergency managed in intensive vs intermediate care settings: a multihospital retrospective cohort study.” Annals of the American Thoracic Society (2026). PMID: 41915559 ↗
L2bCOHORTCited in: Pathophysiology, History and Physical Examination, Management - [65]
Song T, Han Y, Xie L et al.. “Cellular Heterogeneity in Aortic Aneurysm and Dissection: Molecular Mechanisms and Therapeutic Opportunities.” Circulation research (2026). PMID: 41886549 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology - [66]
Hu M, Chen B, Luo Y. “Computational fluid dynamics modelling of hemodynamics in aortic aneurysm and dissection: a review.” Frontiers in bioengineering and biotechnology (2025). PMID: 40190707 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology - [67]
Jia Q, Bian Y, Wang X et al.. “Case Report: Diagnostic pitfalls in localized aortic root dissection: two cases and a literature review.” Frontiers in cardiovascular medicine (2026). PMID: 41953663 ↗
L4CASE_REPORTCited in: Pathophysiology - [68]
Cosco V, Grenci G, Fiorentino A et al.. “Limited Iatrogenic Dissection of the Aortic Root: To Treat or Not to Treat?” Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2025). PMID: 41078216 ↗
L4CASE_REPORTCited in: Pathophysiology, Clinical Features and Variants - [69]
Kelly JJ, Brown CR, Eisenga JB et al.. “Repair of Arch Aneurysm With Frozen Elephant Trunk for DeBakey Type I Dissection Previously Treated With a Hybrid Arch Bare-Metal Stent.” The Annals of thoracic surgery (2025). PMID: 40609665 ↗
L4CASE_REPORTCited in: Pathophysiology - [70]
Cui P, Sun HH, Luo Y et al.. “Aortic dissection: the role of macrophages in disease pathogenesis and their potential as a treatment target.” Journal of cardiothoracic surgery (2026). PMID: 41765885 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology - [71]
Bissell MM, Garg P. “Clinical 4D flow MRI assessment in aortopathy-what the clinician needs to know.” Cardiovascular diagnosis and therapy (2025). PMID: 41509618 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology - [72]
Clothier JS, Kobsa S. “Management of Acute Type A Aortic Dissection.” Cardiology clinics (2025). PMID: 40268355 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology - [73]
Ahmad HM, Iskandar Z, Lang CC et al.. “Emerging imaging and circulating biomarkers in relation to underlying mechanisms in Bicuspid Aortic Valve aortopathy.” International journal of cardiology. Heart & vasculature (2025). PMID: 40130209 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology - [74]
Murtada A, Jubouri M, Refaie M et al.. “Nonocclusive Mesenteric Ischemia in Aortic Surgery: What You Need to Know.” Annals of vascular surgery (2025). PMID: 39863280 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology - [75]
Al-Rawi M, Lim ETA, Khashram M et al.. “Utility of Computational Modeling in Reassessing the Threshold for Intervention and Progression into Type A Aortic Dissection.” Biomedicines (2026). PMID: 41898340 ↗
L5OTHERCited in: Pathophysiology - [76]
Li B, Zhu Y, Wang K et al.. “Strongly coupled fluid-structure interaction analysis of TEVAR with double-branched endograft for non-A non-B aortic dissection: a patient-specific case study.” Journal of biomechanics (2026). PMID: 41391440 ↗
L5OTHERCited in: Pathophysiology - [77]
Liu W, Lin Q, Zhong H et al.. “Microbiomics and metabolomics explored the characteristics of gut microbiota and metabolites in patients with aortic dissection.” Frontiers in cellular and infection microbiology (2025). PMID: 41132489 ↗
L5OTHERCited in: Pathophysiology, History and Physical Examination - [78]
Kario K, Okawara Y, Kanegae H et al.. “Relationship Between Home Blood Pressure Monitoring-Confirmed Resistant Hypertension and Cardiovascular Prognosis.” Hypertension (Dallas, Tex. : 1979) (2025). PMID: 41127912 ↗
L5OTHERCited in: Pathophysiology, History and Physical Examination - [79]
Osswald A, Tsagakis K, Thielmann M et al.. “Can computational fluid dynamics simulations predict a distal stent graft-induced new entry after frozen elephant trunk operation?” Frontiers in cardiovascular medicine (2025). PMID: 41112231 ↗
L5OTHERCited in: Pathophysiology - [80]
Kario K, Nishiyama A, Shibata S et al.. “The JSH Morning Hypertension Eradication Program Project.” Hypertension research : official journal of the Japanese Society of Hypertension (2025). PMID: 40858749 ↗
L5OTHERCited in: Pathophysiology, History and Physical Examination, Differential Diagnosis - [81]
Wu T, Zhu H, Zhuo H et al.. “Fluid-structure interaction study of penetrating atherosclerotic ulcers: Assessing progression and rupture risks.” Computer methods and programs in biomedicine (2025). PMID: 40706491 ↗
L5OTHERCited in: Pathophysiology, History and Physical Examination, Clinical Features and Variants - [82]
Zhang L, Yang S, Guo X et al.. “Changes in True and False Lumen Pressures During Closure of the Primary Tear in Aortic Dissection.” Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2025). PMID: 40665556 ↗
L5OTHERCited in: Pathophysiology, History and Physical Examination - [83]
Chen Y, Guo J, Wang S et al.. “Identifying Hemodynamic Predictors of Aortic Growth After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection.” Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2025). PMID: 40650600 ↗
L5OTHERCited in: Pathophysiology - [84]
Larsen KSR, Tang M, Budtz-Lilly JW et al.. “Evaluation of a Rehabilitation Program With Blood Pressure-Guided Exercise Intensity Restrictions for Patients With Thoracic Aortic Dissection or Aneurysm.” Journal of cardiopulmonary rehabilitation and prevention (Unknown). PMID: 40627738 ↗
L5OTHERCited in: Pathophysiology, History and Physical Examination - [85]
Chen N, Downing JV, Epstein J et al.. “Emergency Department Blood Pressure Management in Type B Aortic Dissection: An Analysis with Machine Learning.” The western journal of emergency medicine (2025). PMID: 40561988 ↗
L5OTHERCited in: Pathophysiology, History and Physical Examination - [86]
Öster H, Chen T, Mennander A et al.. “CMKLR-1 Expression in Human Aorta Is Dominated by Smooth Muscle Cell Positivity.” The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society (2025). PMID: 40552467 ↗
L5OTHERCited in: Pathophysiology - [87]
Chen X, Xie L, Wu Q et al.. “Development and validation of a novel prognostic score to improve prognostic prediction in patients with type B aortic dissection.” Journal of vascular surgery (2025). PMID: 40541619 ↗
L5OTHERCited in: Pathophysiology - [88]
Balasubramanya A, Gheysen L, Wagenhäuser MU et al.. “Hemodynamics in aortic dissections: A fluid-solid interaction study in an idealized dissection model with a false lumen side branch.” Journal of biomechanics (2025). PMID: 40449253 ↗
L5OTHERCited in: Pathophysiology - [89]
Wang X, Song F, Jiang L et al.. “Efficacy and Safety of Sacubitril/Valsartan in Chronic Type B Aortic Dissection Combined With Mild Hypertension.” American journal of hypertension (2024). PMID: 38564196 ↗
L1bRCTCited in: History and Physical Examination - [90]
Zhu YL, Wang S, Gu Y et al.. “Efficacy of predictive pain intervention in patients with aortic dissection.” Technology and health care : official journal of the European Society for Engineering and Medicine (2024). PMID: 38943408 ↗
L1bRCTCited in: History and Physical Examination - [91]
Song W, Liu J, Tu G et al.. “Impact of body mass index on perioperative mortality of acute stanford type A aortic dissection: a systematic review and meta-analysis.” BMC cardiovascular disorders (2023). PMID: 37907847 ↗
L2aSR_OBSCited in: History and Physical Examination - [92]
Xiao Y, Huang S, Zheng D et al.. “Delayed Diagnosis of Aortic Dissection: A Scoping Review.” Reviews in cardiovascular medicine (2025). PMID: 40630449 ↗
L2aSR_OBSCited in: History and Physical Examination - [93]
Oztas DM, Ozdemir E, Bauernschmitt R et al.. “Transcatheter aortic valve implantation for pure aortic insufficiency in a patient following David-type aortic valve-sparing root replacement after aortic dissection-A successful off-label procedure.” Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2024). PMID: 38577923 ↗
L4CASE_REPORTCited in: History and Physical Examination - [94]
Gillinov LA, Kapoor SR, Sperry AE et al.. “Fate of the Aortic Root After Reconstruction With Felt Neomedia for Acute Type A Aortic Dissection.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2026). PMID: 41557464 ↗
L5OTHERCited in: History and Physical Examination - [95]
Zhao R, Liu Y, Zhang B et al.. “Concomitant Aortic Root Replacement in Total Arch Replacement With Frozen Elephant Trunk for Type A Aortic Dissection: A Propensity-Weighted Analysis.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2026). PMID: 41410509 ↗
L5OTHERCited in: History and Physical Examination, Supportive Care and Complication Management - [96]
Wagner CM, Marway PS, Ferrel MN et al.. “Sex differences in ascending aortic diameter at the time of acute type A aortic dissection.” Heart (British Cardiac Society) (2026). PMID: 41083213 ↗
L5OTHERCited in: History and Physical Examination - [97]
Ikeno Y, Tanaka A, Estrera GA et al.. “Aortic Root Reconstruction With Pledgeted Sutures in Patients With Acute Type A Aortic Dissection.” The Annals of thoracic surgery (2026). PMID: 40681029 ↗
L5OTHERCited in: History and Physical Examination - [98]
Norton EL, Arora A, Cangut B et al.. “Association of intraoperative transfusion of blood products with postoperative outcomes and midterm survival in acute type A aortic dissection repair.” JTCVS open (2025). PMID: 40061521 ↗
L5OTHERCited in: History and Physical Examination - [99]
Ho CH, Lin CP, Chang FC et al.. “Blood Pressure and Heart Rate Management in Patients After Repair of Type A Aortic Dissection.” The Annals of thoracic surgery (2025). PMID: 40057152 ↗
L5OTHERCited in: History and Physical Examination - [100]
Jiang B, Ren P, He C et al.. “Short-term disruption of TGF-β signaling in adult mice renders the aorta vulnerable to hypertension-induced dissection.” JCI insight (2025). PMID: 39932797 ↗
L5OTHERCited in: History and Physical Examination - [101]
Chen D, Fang K, Luo M et al.. “Aortic Dissection Incidence and Risk Factor Analysis: Findings from the China Kadoorie Biobank.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2025). PMID: 39643204 ↗
L5OTHERCited in: History and Physical Examination - [102]
Leshnower BG, Farrington WJ, Huckaby LV et al.. “Long-term Results of Valve-Sparing Aortic Root Replacement in Acute Type A Aortic Dissection.” The Annals of thoracic surgery (2025). PMID: 39293750 ↗
L5OTHERCited in: History and Physical Examination - [103]
Kario K, Okawara Y, Kanegae H et al.. “Peak nocturnal home blood pressure as an early and strong novel risk factor for stroke: the practitioner-based nationwide J-HOP Nocturnal BP study.” Hypertension research : official journal of the Japanese Society of Hypertension (2025). PMID: 39242824 ↗
L5OTHERCited in: History and Physical Examination - [104]
Zhang K, Zhou C, Gao S et al.. “The optimal degree of core temperature for hypothermic circulatory arrest in complex aortic arch surgery: results from 1310 patients.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2024). PMID: 39137134 ↗
L5OTHERCited in: History and Physical Examination - [105]
Kario K, Kanegae H, Okawara Y et al.. “Home Blood Pressure Variability Risk Prediction Score for Cardiovascular Disease Using Data From the J-HOP Study.” Hypertension (Dallas, Tex. : 1979) (2024). PMID: 39136129 ↗
L5OTHERCited in: History and Physical Examination - [106]
Elbatarny M, Trimarchi S, Korach A et al.. “Axillary vs Femoral Arterial Cannulation in Acute Type A Dissection: International Multicenter Data.” The Annals of thoracic surgery (2024). PMID: 38458510 ↗
L5OTHERCited in: History and Physical Examination, Landmark Trials and Key Evidence - [107]
Ahmad RA, Orelaru F, Arora A et al.. “Acute type A intramural hematoma: The less-deadly acute aortic syndrome?” The Journal of thoracic and cardiovascular surgery (2025). PMID: 38280668 ↗
L5OTHERCited in: History and Physical Examination - [108]
Ripley B, Scheidt MJ, Aghayev A et al.. “ACR Appropriateness Criteria® Thoracic Aortic Aneurysm or Dissection-Treatment Planning and Follow-Up: 2024 Update.” Journal of the American College of Radiology : JACR (2025). PMID: 40409894 ↗
L1cGUIDELINECited in: Clinical Features and Variants, Guidelines and Resources - [109]
Esfahanian F, Madani MH. “Clinical and Imaging Features of Aortic Penetrating Atherosclerotic Ulcers: A Systematic Review and Meta-Analysis.” Journal of clinical medicine (2026). PMID: 41682880 ↗
L2aSR_OBSCited in: Clinical Features and Variants, Management - [110]
Goodacre S, Pandor A, Thokala P et al.. “Diagnostic strategies for suspected acute aortic syndrome: systematic review, meta-analysis, decision-analytic modelling and value of information analysis.” Health technology assessment (Winchester, England) (2025). PMID: 40944621 ↗
L2aSR_OBSCited in: Clinical Features and Variants - [111]
Anezaki H, Aoki Y, Kato H et al.. “Perioperative cardiac arrest requiring admission to intensive care units in Japan: epidemiological differences between emergency and elective surgery from a multicentre cohort study.” British journal of anaesthesia (2025). PMID: 40713194 ↗
L2bCOHORTCited in: Clinical Features and Variants - [112]
Yao YT, Xie CM, Wang HB et al.. “Acute type A aortic dissection patients undergoing surgical repair during the COVID-19 pandemic.” Medicine (2025). PMID: 40295228 ↗
L2aSR_OBSCited in: Clinical Features and Variants - [113]
Yang KJ, Chi NH, Yu HY et al.. “Endovascular vs. open surgical repair in retrograde type a dissection & intramural hematoma: A study-level meta-analysis.” Interdisciplinary cardiovascular and thoracic surgery (2025). PMID: 40991360 ↗
L2aSR_OBSCited in: Clinical Features and Variants - [114]
Ayhan C, Mekhaeil M, Channawi R et al.. “Applications of Artificial Intelligence as a Prognostic Tool in the Management of Acute Aortic Syndrome and Aneurysm: A Comprehensive Review.” Journal of clinical medicine (2025). PMID: 41375721 ↗
L5REVIEW_NARRATIVECited in: Clinical Features and Variants - [115]
Kamel S, Chastant R, Alric P et al.. “Single- and Double-Fenestrated Physician-Modified Stent Grafts for Emergent Aortic Arch Lesions.” Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2025). PMID: 41200840 ↗
L5REVIEW_NARRATIVECited in: Clinical Features and Variants - [116]
Chochoł P, Witt-Majchrzak A, Mycko MP. “Dissected Thoracic Aorta Masked as Seizures: A Case Report.” Journal of clinical medicine (2026). PMID: 41682827 ↗
L4CASE_REPORTCited in: Clinical Features and Variants - [117]
Pignataro G, Scafetta A, De Luca D et al.. “The Role of Biomarkers and Clinical Prediction Tools in the Diagnosis of Acute Aortic Syndromes: A Literature-Based Review.” Medicina (Kaunas, Lithuania) (2025). PMID: 41010942 ↗
L5REVIEW_NARRATIVECited in: Clinical Features and Variants - [118]
Rahman I, Ali J, De Silva R. “Cannulation Strategies for Aortic Arch Surgery.” Journal of cardiovascular development and disease (2025). PMID: 41002639 ↗
L5REVIEW_NARRATIVECited in: Clinical Features and Variants - [119]
Garg I, Grist TM, Nagpal P. “MR Angiography for Aortic Diseases.” Cardiology clinics (2025). PMID: 40268353 ↗
L5REVIEW_NARRATIVECited in: Clinical Features and Variants - [120]
Sica G, Rea G, Lieto R et al.. “CT diagnosis and destiny of acute aortic intramural hematoma.” Frontiers in radiology (2025). PMID: 40134989 ↗
L5REVIEW_NARRATIVECited in: Clinical Features and Variants - [121]
Cai Z, Yan T, Wang H et al.. “Impact of an emergency department bypass referral pathway for surgically managed Type A aortic dissection diagnosed at non-aortic centers.” Frontiers in public health (2025). PMID: 41924021 ↗
L5OTHERCited in: Clinical Features and Variants, Management - [122]
Apostolidis G, Nana P, Panuccio G et al.. “A Retrospective Analysis of Barb-mediated Active Fixation Impact on Thoracic Endovascular Aortic Repair Outcomes.” Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2026). PMID: 41857800 ↗
L5OTHERCited in: Clinical Features and Variants, Management - [123]
Bhat S, Bhat S, Schreve F et al.. “d-Dimer With the Aortic Dissection Detection Risk Score May Improve Patient Selection for Acute Aortic Syndrome Diagnostic Imaging.” Emergency medicine Australasia : EMA (2026). PMID: 41582603 ↗
L5OTHERCited in: Clinical Features and Variants - [124]
Meinert ÉFRC, Kremer J, Farag M et al.. “Outcomes of total arch replacement and frozen elephant trunk in acute aortic syndrome.” Frontiers in cardiovascular medicine (2025). PMID: 41552679 ↗
L5OTHERCited in: Clinical Features and Variants, Supportive Care and Complication Management - [125]
Yang J, Zhang X, Lou D et al.. “First in Human Evaluation of an Innovative Stent Graft for Endovascular Repair of Acute Ascending Aortic Syndromes.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2025). PMID: 41391565 ↗
L5OTHERCited in: Clinical Features and Variants, Differential Diagnosis - [126]
Keyoumu R, Wang Y, Liu R et al.. “Three Dimensional Printing Assisted Multi-fenestrated Endovascular Repair of the Aortic Arch: A Multicentre Study.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2025). PMID: 41380763 ↗
L5OTHERCited in: Clinical Features and Variants - [127]
Schönbeck H, Björkelund A, Møller ES et al.. “A missed diagnosis of acute aortic syndrome is associated with ischaemic ECG changes and an initial suspicion of myocardial infarction: a retrospective observational study.” BMC emergency medicine (2025). PMID: 41315990 ↗
L5OTHERCited in: Clinical Features and Variants, Differential Diagnosis - [128]
Xu W, Haran C, Lim E et al.. “Nationwide outcomes of early thoracic endovascular aortic repair for type B aortic dissection.” Journal of vascular surgery (2026). PMID: 41177275 ↗
L5OTHERCited in: Clinical Features and Variants, Supportive Care and Complication Management - [129]
Besola L, Biasci L, Mangifesta C et al.. “Warming up the frozen elephant trunk for aortic arch pathology.” Annals of cardiothoracic surgery (2025). PMID: 41098994 ↗
L5OTHERCited in: Clinical Features and Variants - [130]
Voetsch A, Gottardi R, Winkler A et al.. “Frozen Elephant Trunk in Acute Aortic Syndrome: Retrospective Results from a Low-Volume Center.” Journal of clinical medicine (2025). PMID: 41095777 ↗
L5OTHERCited in: Clinical Features and Variants - [131]
Ullery BW, Alie-Cusson F, Magee GA et al.. “Laser in situ fenestrated endograft (LIFE) repair of complex aortic arch pathology: Early outcomes from the multicenter LIFE registry.” Journal of vascular surgery (2026). PMID: 41075877 ↗
L5OTHERCited in: Clinical Features and Variants - [132]
Francesco Squizzato, D'Oria M, Antonello M et al.. “Editor's Choice - International Expert Consensus on the Management of Acute Aortic Type B Intramural Haematoma and Penetrating Ulcer.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2026). PMID: 41038380 ↗
L5OTHERCited in: Clinical Features and Variants - [133]
Cui D, Li X, Chen Y et al.. “Risk Factor Analysis of Post-TEVAR Distal Aortic Expansion: A Systematic Review and Meta-Analysis.” Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2026). PMID: 41833301 ↗
L2aSR_OBSCited in: Differential Diagnosis, Management - [134]
Kushnir Y, Barrera N, Arias-Sanchez P et al.. “Intensified blood pressure control during hospital admission and on discharge: a systematic review and meta-analysis of retrospective cohort studies.” Frontiers in cardiovascular medicine (2026). PMID: 41725942 ↗
L2aSR_OBSCited in: Differential Diagnosis - [135]
Benabbas R, Zehtabchi S, Wakai A et al.. “Cardiac Biomarkers, Echocardiography, and Outpatient Cardiac Monitoring for Evaluation of Emergency Department Patients With Syncope: A Systematic Review and Analysis of Direct Evidence for SAEM GRACE.” Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (2026). PMID: 41201260 ↗
L2aSR_OBSCited in: Differential Diagnosis - [136]
Qazi SU, Zaide DB, Fatima U et al.. “Long term outcomes of thoracic endovascular repair versus optimal medical therapy for uncomplicated Stanford type B aortic dissection: a systematic review and meta-analysis.” Future cardiology (2025). PMID: 40923587 ↗
L2aSR_OBSCited in: Differential Diagnosis - [137]
Nouri A, Awashra A, Hamdan D et al.. “Cardiovascular toxicity of Fruquintinib in patients with colorectal and other cancers: a systematic review and meta-analysis.” Cardio-oncology (London, England) (2025). PMID: 40993794 ↗
L2aSR_OBSCited in: Differential Diagnosis - [138]
Fukano K, Sasabuchi Y, Matsui H et al.. “Preoperative coronary angiography and outcomes in acute type A aortic dissection with coronary malperfusion: A retrospective cohort study.” Cardiovascular revascularization medicine : including molecular interventions (2025). PMID: 41125468 ↗
L2bCOHORTCited in: Differential Diagnosis - [139]
Li XD, Chen ZJ. “Aortic dissection disguised as musculoskeletal condition: a case report and review of literature.” BMC musculoskeletal disorders (2025). PMID: 41023648 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [140]
Lu G, Wang X, Wang X et al.. “Case Report: Rapid progression of inflammation-driven coronary artery lesions in a normolipidemic patient with ANCA-associated vasculitis complicated by Stanford type A aortic dissection.” Frontiers in immunology (2026). PMID: 41909680 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [141]
Qiu F, Luo L, Huang J et al.. “Case Report: Improved axillary artery cannulation and extracorporeal membrane oxygenation bridging therapy for cardiogenic shock caused by Marfan syndrome combined with aortic dissection.” Frontiers in cardiovascular medicine (2026). PMID: 41908050 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [142]
Ji B, Lai Y, Liu XB et al.. “Aortic Root Dissection Masquerading as Acute Coronary Syndrome: The Critical Role of Intravascular Ultrasound.” Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2026). PMID: 41264798 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [143]
Wang H, Bello J, Gala D et al.. “Aortic Dissection With Pseudoaneurysm Formation Masquerading as Pulmonary Embolism After Transcatheter Aortic Valve Replacement.” Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2025). PMID: 40908904 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [144]
Leinweber ME, Hofmann AG. “Seasonality of Selected Cardiovascular Disorders in Austria: A Retrospective Observational Study Between 2009 and 2023.” Journal of the American Heart Association (2026). PMID: 41988963 ↗
L5OTHERCited in: Differential Diagnosis - [145]
Patel S, Desai ND, Brinster DR et al.. “Type A acute aortic dissection complicated by preoperative myocardial infarction: Insights from the International Registry of Acute Aortic Dissection.” JTCVS open (2026). PMID: 41960051 ↗
L5OTHERCited in: Differential Diagnosis, Landmark Trials and Key Evidence - [146]
Luo Y, Peng J, Peng W et al.. “Development and evaluation of an artificial intelligence-based electrocardiogram prediction model for emergency chest pain patients.” Frontiers in medicine (2026). PMID: 41884147 ↗
L5OTHERCited in: Differential Diagnosis - [147]
Zhou F, Zhou X, Yang L et al.. “Evaluation of CT-FFR for Predicting Myocardial Ischaemia in Patients With Type A Aortic Dissection.” European heart journal. Cardiovascular Imaging (2026). PMID: 41748322 ↗
L5OTHERCited in: Differential Diagnosis - [148]
Kwinta A, Bielański P, Szkudlarek O et al.. “Feasibility and outcomes of anaesthesiology- and intensive care-led ECPR in a hospital without cardiac surgery: a 2.5-year prospective registry.” BMC anesthesiology (2026). PMID: 41699484 ↗
L5OTHERCited in: Differential Diagnosis - [149]
Wan Z, Jama K, Hasemaki N et al.. “Outcomes after Endovascular Arch Repair in Patients with a Native Ascending Aorta Diameter Greater than 38 mm: An Observational Study in Two High Volume Centres.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2026). PMID: 41554372 ↗
L5OTHERCited in: Differential Diagnosis - [150]
Fujiyoshi T, Kumamaru H, Ogino H et al.. “Surgical treatment for acute aortic dissection with coronary malperfusion in Japan: Nationwide database analysis.” JTCVS open (2025). PMID: 41473077 ↗
L5OTHERCited in: Differential Diagnosis - [151]
Zhou Y, Chen C, Li J et al.. “Identification and Validation of Differentially Expressed mRNAs From Peripheral Leukocytes for Acute Stanford Type A Aortic Dissection.” Journal of the American Heart Association (2025). PMID: 41378480 ↗
L5OTHERCited in: Differential Diagnosis - [152]
Hoppe JM, Schramm MC, Diegruber K et al.. “Identification of diagnostic markers for MINOCA in ST-segment elevation myocardial infarction patients.” Frontiers in cardiovascular medicine (2025). PMID: 41341294 ↗
L5OTHERCited in: Differential Diagnosis - [153]
Szeto WY, Fukuhara S, Fleischman F et al.. “One-Year Results of Novel Aortic Arch Hybrid Prosthesis for Repair of Acute DeBakey Type I Dissection With Malperfusion: PERSEVERE Study.” The Annals of thoracic surgery (2025). PMID: 41238072 ↗
L5OTHERCited in: Differential Diagnosis - [154]
Tang J, Chen F, Wu D. “Early auxiliary diagnosis model for chest pain triad based on artificial intelligence multimodal fusion.” JAMIA open (2025). PMID: 41041626 ↗
L5OTHERCited in: Differential Diagnosis - [155]
Haimovich JS, Kolossváry M, Alam R et al.. “Risk stratification of chest pain in the emergency department using artificial intelligence applied to electrocardiograms.” Open heart (2025). PMID: 40889954 ↗
L5OTHERCited in: Differential Diagnosis - [156]
Guo W, Sun G, Zhang H et al.. “The G-branch off-the-shelf mixed branch endograft for thoracoabdominal aortic aneurysm: 1-year results from a prospective multicenter study.” International journal of surgery (London, England) (2025). PMID: 40865966 ↗
L5OTHERCited in: Differential Diagnosis - [157]
Irshad S, Adrejiya P, Abubaker M et al.. “Kommerell's Diverticulum Masquerading in a Right Aortic Arch: A Vascular Surprise.” Methodist DeBakey cardiovascular journal (2025). PMID: 40860769 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [158]
Papakonstantinou NA, Antonopoulos CN. “Extracorporeal Membrane Oxygenation Following Acute Type A Aortic Dissection Repair: A Systematic Review and Meta-Analysis.” ASAIO journal (American Society for Artificial Internal Organs : 1992) (2026). PMID: 41736226 ↗
L2aSR_OBSCited in: Management, Supportive Care and Complication Management - [159]
Amvrazi AV, Antonopoulos CN, Spath P et al.. “Outcomes of Custom Made and Off the Shelf Endografts for Preservation of the Left Subclavian Artery during Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-analysis.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2026). PMID: 41905582 ↗
L2aSR_OBSCited in: Management - [160]
Donndorf P, Angles T, Schafmayer C et al.. “Urgent and Emergent Endovascular Treatment of the Downstream Aorta Soon After Open Surgical Repair in Acute Type A Aortic Dissection: Analyzing Indications and Outcomes of an Institutional Case Series.” Journal of clinical medicine (2026). PMID: 41682617 ↗
L4CASE_REPORTCited in: Management - [161]
Gu JJ, Zhao TY, Tian XC et al.. “Mixed Reality-Assisted Thoracic Endovascular Aortic Repair: A Retrospective Study on Efficacy and Safety.” Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc (2026). PMID: 41913345 ↗
L2bCOHORTCited in: Management, Supportive Care and Complication Management - [162]
Peng HH, Fang QB, Wang L et al.. “Modified Candy Plug for False Lumen Embolization in Chronic Aortic Dissection: Technical Aspects and Initial Experience.” Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2026). PMID: 41978486 ↗
L5OTHERCited in: Management - [163]
Marzano A, Gagliardo di Carpinello G, Giordano A et al.. “Dedicated Single-Branch Platforms for Totally Endovascular Zone 2 TEVAR with LSA Revascularization: A Comparison of Castor/Cratos and Gore TAG Thoracic Branch Endoprosthesis.” Journal of clinical medicine (2026). PMID: 41976960 ↗
L5REVIEW_NARRATIVECited in: Management - [164]
Fang J, Cao Z, Zhang Y et al.. “Outcomes of Zone 1 Thoracic Endovascular Aortic Repair with Single Branched Stent Graft and Left Common Carotid Artery Chimney Stenting for Zone 2 Aortic Arch Pathologies.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2026). PMID: 41936860 ↗
L5OTHERCited in: Management - [165]
Li N, Ge S, Hu J et al.. “Castor stent reconstruction of left subclavian artery reduces the incidence of postoperative cerebral infarction of type B aortic dissection with insufficient proximal landing area: a propensity score matched analysis.” Frontiers in cardiovascular medicine (2026). PMID: 41908054 ↗
L5OTHERCited in: Management - [166]
Deng L, Li H, Yu W et al.. “Mid-and Long-Term Outcomes of Thoracic Endovascular with branch artery revascularization in the Aortic Repair for Non-A Non-B Aortic Dissection.” Seminars in thoracic and cardiovascular surgery (2026). PMID: 41903628 ↗
L5OTHERCited in: Management - [167]
Atash A, Mees BME, Cramer MJ et al.. “MYH11 variants in thoracic aortic aneurysm pathophysiology: From bench to bedside.” European journal of clinical investigation (2026). PMID: 41891259 ↗
L5REVIEW_NARRATIVECited in: Management - [168]
Keschenau PR, Bandzius N, Weiß B et al.. “Effect of the Proximal Landing Zone Quality on TEVAR Outcomes-11-Year Real-World Experience with the Relay Stent Graft Family in Aortic Dissections.” Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2026). PMID: 41872993 ↗
L5OTHERCited in: Management - [169]
D'Onofrio A, Caraffa R, Cibin G et al.. “Suitability Analysis of 2 Devices for Endovascular Aortic Arch Repair Following Type A Aortic Dissection Surgery.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2026). PMID: 41803625 ↗
L5OTHERCited in: Management - [170]
Zhao Y, Qian J, He H et al.. “A Novel Method Improving Estimation of Distal Landing Zone and Remodeling in Endovascular Repair of Type B Aortic Dissection.” Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2026). PMID: 41728920 ↗
L5OTHERCited in: Management - [171]
Tinelli G, Sica S, Tsilimparis N et al.. “Open surgery versus branched endovascular repair of the aortic arch in residual dissections after type A surgical repair.” The British journal of surgery (2026). PMID: 41701205 ↗
L5OTHERCited in: Management, Supportive Care and Complication Management - [172]
Jiang X, Fu W, Lu W et al.. “Intimo-Intimal Intussusception during Endovascular Repair of Type B Aortic Dissection.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2026). PMID: 41679455 ↗
L5OTHERCited in: Management - [173]
Dean A, Feng K, Hassan S et al.. “Midterm Outcomes of the Knickerbocker Technique following Thoracic Endovascular Aortic Repair for Chronic Post-dissection Thoracic Aortic Aneurysms: A Single Centre Experience.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2026). PMID: 41672344 ↗
L5OTHERCited in: Management - [174]
Wang F, Li H, Wang Y et al.. “Endovascular treatment of retrograde type A aortic dissection: a decade of experience in a single-center.” Frontiers in cardiovascular medicine (2026). PMID: 41623614 ↗
L5OTHERCited in: Management - [175]
Jiang X, Zou L, Liu H et al.. “Endovascular Repair for Type B Aortic Dissection Accompanied by Retrograde Intramural Haematoma.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2026). PMID: 41619797 ↗
L5OTHERCited in: Management, Supportive Care and Complication Management - [176]
Boshkoski G, Natour D, Jankulovski A et al.. “First Reported Use of the AMDS Hybrid Prosthesis for Secondary Type A Aortic Dissection After Prior TEVAR.” Journal of cardiovascular development and disease (2026). PMID: 41892729 ↗
L4CASE_REPORTCited in: Management - [177]
Pitts L, Kofler M, Montagner M et al.. “Total Arch Replacement with a New Hybrid Device to Manage the Left Subclavian Artery in the Frozen Elephant Trunk Technique.” Interdisciplinary cardiovascular and thoracic surgery (2026). PMID: 41808447 ↗
L4CASE_REPORTCited in: Management - [178]
Asta L, Mancini V, Mantini C et al.. “Aortic dissection in a Jehovah's witness: Frozen Elephant Trunk and subsequent 4D flow MRI analysis, a case report.” Journal of cardiothoracic surgery (2026). PMID: 41715223 ↗
L4CASE_REPORTCited in: Management - [179]
Zhao HY, Gan LX, Guo HW. “Fatal delayed superior mesenteric artery thrombosis after frozen elephant trunk repair in acute type a aortic dissection with false lumen perfusion: a case report.” Journal of cardiothoracic surgery (2026). PMID: 41689049 ↗
L4CASE_REPORTCited in: Management - [180]
Santos K, Oya K, Umibe T et al.. “Does Autologous Platelet-Rich Plasma Improve Blood Conservation and Postoperative Outcomes in Acute Type A Aortic Dissection Surgery? A Systematic Review and Meta-Analysis.” Journal of cardiothoracic and vascular anesthesia (2026). PMID: 41107167 ↗
L2aSR_OBSCited in: Supportive Care and Complication Management - [181]
Agard G, Tonon D, Collart F et al.. “Arterial Hypotension During Cardiopulmonary Bypass and Postoperative Lung Injury in Patients Undergoing Urgent Surgery for Acute Type A Aortic Dissection: A Propensity Score-matched Retrospective Cohort Study.” Journal of cardiothoracic and vascular anesthesia (2026). PMID: 41193309 ↗
L2bCOHORTCited in: Supportive Care and Complication Management - [182]
Bohatch Júnior MS, de Melo Silva B, Soares EAG et al.. “Endovascular Repair in High-Risk Uncomplicated Type B Aortic Dissection: A Systematic Review and Single-Arm Meta-Analysis.” Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2026). PMID: 41578935 ↗
L2aSR_OBSCited in: Supportive Care and Complication Management - [183]
Matsumoto R, Watanabe T, Kinoshita R et al.. “Sex-Based Differences in Dissection Patterns and Surgical Strategies in Tear-Oriented Repair for Acute Type A Aortic Dissection: A Single-Center Retrospective Study.” Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia (2026). PMID: 41565270 ↗
L2bCOHORTCited in: Supportive Care and Complication Management - [184]
Ye M, Xue C, Wang D et al.. “Endovascular reperfusion followed by delayed open aortic repair in stable acute type A aortic dissection with malperfusion syndrome: a single-center experience.” Frontiers in medicine (2025). PMID: 41755990 ↗
L5OTHERCited in: Supportive Care and Complication Management - [185]
Takauchi T, Hirao S, Yaegashi K et al.. “Lateral Ventricular Symmetry as a Predictor of Postoperative Neurological Outcomes in Acute Type A Aortic Dissection With Cerebral Malperfusion.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2026). PMID: 41656890 ↗
L5OTHERCited in: Supportive Care and Complication Management - [186]
Ma WG, Chen Y, Chen SW et al.. “Frozen elephant trunk for acute type A aortic dissection: long-term outcomes over two decades.” European heart journal (2026). PMID: 41614598 ↗
L5OTHERCited in: Supportive Care and Complication Management - [187]
Sohn B, Lee JH, Lee H et al.. “Central Aortic Cannulation as a Primary Strategy in Acute Type A Aortic Dissection Surgery.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2026). PMID: 41570093 ↗
L5OTHERCited in: Supportive Care and Complication Management - [188]
Giuffrè G, Pennetta FF, Palmier M et al.. “Impact of false lumen occluders on aortic remodeling after endovascular repair of chronic type B dissection.” Journal of vascular surgery (2026). PMID: 41512935 ↗
L5OTHERCited in: Supportive Care and Complication Management - [189]
Mei X, Ji S, Jiang Y et al.. “Preoperative serum Raman spectroscopy and machine learning for predicting postoperative acute kidney injury after acute type A aortic dissection.” Renal failure (2025). PMID: 41503972 ↗
L5OTHERCited in: Supportive Care and Complication Management - [190]
Yalzadeh D, Tabibian K, Sakowitz S et al.. “Surgical repair of type A aortic dissection at safety-net hospitals across the United States.” Surgery (2026). PMID: 41500074 ↗
L5OTHERCited in: Supportive Care and Complication Management - [191]
Yang S, Zhang X, Wu X et al.. “Three-branched in situ laser fenestration for the endovascular repair of total aortic arch disease: A retrospective analysis of 5-year outcomes.” Journal of vascular surgery (2025). PMID: 41423026 ↗
L5OTHERCited in: Supportive Care and Complication Management - [192]
Sato H, Iba Y, Mikami T et al.. “Comparison of 3 Surgical Procedures for DeBakey Type I Acute Aortic Dissection: When Is Frozen Elephant Trunk Recommended?” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2025). PMID: 41247077 ↗
L5OTHERCited in: Supportive Care and Complication Management - [193]
Rebello KR, Green SY, Weldon SA et al.. “Early outcomes for women and men after open extent III thoracoabdominal aortic aneurysm repair.” Journal of vascular surgery (2026). PMID: 41197838 ↗
L5OTHERCited in: Supportive Care and Complication Management - [194]
Chandra VM, Norton EL, Khaja MS et al.. “Surgical and endovascular repair for type B aortic dissections with mesenteric malperfusion syndrome: A systematic review of in-hospital mortality.” JTCVS open (2022). PMID: 36590716 ↗
L2aSR_OBSCited in: Landmark Trials and Key Evidence - [195]
Yip A, Libhaber E, Nam P et al.. “A Systematic Review of Acute Thoracic Aortic Dissections in Africa-The Need for a Registry.” Aorta (Stamford, Conn.) (2022). PMID: 36539145 ↗
L2aSR_OBSCited in: Landmark Trials and Key Evidence - [196]
Harris KM, Parikh NB, Nienaber CA et al.. “Iatrogenic aortic dissection: Insights from the International Registry of Acute Aortic Dissection.” The Journal of thoracic and cardiovascular surgery (2025). PMID: 40414525 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [197]
Gilon D, Korach A, Carbone A et al.. “Cardiac Tamponade Complicating Type A Acute Aortic Dissection: Insights From 25 Years of Registry Research.” JACC. Advances (2025). PMID: 39999651 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [198]
Bossone E, Eagle KA, Nienaber CA et al.. “Acute Aortic Dissection: Observational Lessons Learned From 11 000 Patients.” Circulation. Cardiovascular quality and outcomes (2024). PMID: 39145396 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [199]
Ogami T, Arnaoutakis GJ, Isselbacher EM et al.. “Long-term outcomes after recurrent acute thoracic aortic dissection: Insights from the International Registry of Aortic Dissection.” The Journal of thoracic and cardiovascular surgery (2025). PMID: 38678471 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [200]
Pollari F, Nardi P, Mikus E et al.. “Comparison of 4 mortality scores for surgical repair of type A aortic dissection: a multicentre external validation.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2024). PMID: 38212996 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [201]
Filiberto AC, Ramadan OI, Wang GJ et al.. “Sex disparities in patients with acute aortic dissection: A scoping review.” Seminars in vascular surgery (2023). PMID: 38030323 ↗
L5REVIEW_NARRATIVECited in: Landmark Trials and Key Evidence - [202]
Trimarchi S, Mandigers TJ, Bissacco D et al.. “Twenty-five years of observations from the International Registry of Acute Aortic Dissection (IRAD) and its impact on the cardiovascular scientific community.” The Journal of thoracic and cardiovascular surgery (2024). PMID: 37453718 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [203]
Ogami T, Arnaoutakis GJ, Patel HJ et al.. “Postoperative acute kidney injury after thoracic endovascular aortic repair for acute type B aortic dissection.” Journal of vascular surgery (2023). PMID: 37327951 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [204]
Mehta CK, Chiu S, Hoel AW et al.. “Implementation of a direct-to-operating room aortic emergency transfer program: Expedited management of type A aortic dissection.” The American journal of emergency medicine (2023). PMID: 37270850 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [205]
Trimarchi S, Gleason TG, Brinster DR et al.. “Editor's Choice - Trends in Management and Outcomes of Type B Aortic Dissection: A Report From the International Registry of Aortic Dissection.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2023). PMID: 37201718 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [206]
Arnaoutakis GJ, Ogami T, Patel HJ et al.. “Acute Kidney Injury in Patients Undergoing Surgery for Type A Acute Aortic Dissection.” The Annals of thoracic surgery (2023). PMID: 36370884 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [207]
Wolfe SB, Sundt TM, Isselbacher EM et al.. “Survival after operative repair of acute type A aortic dissection varies according to the presence and type of preoperative malperfusion.” The Journal of thoracic and cardiovascular surgery (2024). PMID: 36333247 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [208]
Catalano MA, Mamdouhi T, Pupovac S et al.. “Age, sex, and contemporary outcomes in surgical repair of type A aortic dissection: Insights from the National Inpatient Sample.” JTCVS open (2022). PMID: 36172443 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [209]
Harris KM, Nienaber CA, Peterson MD et al.. “Early Mortality in Type A Acute Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection.” JAMA cardiology (2022). PMID: 36001309 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [210]
Slaven J, Evans M, Partyka C et al.. “Characteristics, clinical findings and outcomes of acute aortic dissection: A comparison between an Australian emergency department and the International Registry of Acute Aortic Dissection.” Emergency medicine Australasia : EMA (2022). PMID: 35636964 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [211]
Ganapathi AM, Ranney DN, Peterson MD et al.. “Location of Aortic Enlargement and Risk of Type A Dissection at Smaller Diameters.” Journal of the American College of Cardiology (2022). PMID: 35550685 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [212]
Reutersberg B, Gleason T, Desai N et al.. “Neurological event rates and associated risk factors in acute type B aortic dissections treated by thoracic aortic endovascular repair.” The Journal of thoracic and cardiovascular surgery (2024). PMID: 35260280 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [213]
Hemli JM, Pupovac SS, Gleason TG et al.. “Management of acute type A aortic dissection in the elderly: an analysis from IRAD.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2022). PMID: 34977934 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [214]
Reutersberg B, Trimarchi S, Gilon D et al.. “Pleural effusion: a potential surrogate marker for higher-risk patients with acute type B aortic dissections.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2022). PMID: 34966915 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [215]
Kalogerakos PD, Zafar MA, Li Y et al.. “Root Dilatation Is More Malignant Than Ascending Aortic Dilation.” Journal of the American Heart Association (2021). PMID: 34238012 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [216]
Angleitner P, Brinster DR, Gleason TG et al.. “Type A Acute Aortic Dissection Presenting With Cerebrovascular Accident at Advanced Age.” Seminars in thoracic and cardiovascular surgery (2022). PMID: 34146671 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [217]
Huckaby LV, Sultan I, Trimarchi S et al.. “Sex-Based Aortic Dissection Outcomes From the International Registry of Acute Aortic Dissection.” The Annals of thoracic surgery (2022). PMID: 34090668 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [218]
Loor G, Gleason TG, Myrmel T et al.. “Effect of Aortic Valve Type on Patients Who Undergo Type A Aortic Dissection Repair.” Seminars in thoracic and cardiovascular surgery (2022). PMID: 33984483 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [219]
Harky A, Mason S, Othman A et al.. “Outcomes of acute type A aortic dissection repair: Daytime versus nighttime.” JTCVS open (2021). PMID: 36003743 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [220]
Lin TW, Tsai MT, Wu HY et al.. “Outcomes of acute type A aortic dissection operations performed by early-career cardiovascular surgeons.” JTCVS open (2021). PMID: 36003577 ↗
L5OTHERCited in: Landmark Trials and Key Evidence - [221]
Eghan P, Folson AA, Donkor A et al.. “Relationship between hypertensive disorders of pregnancy (HDP) and cardiac remodeling during pregnancy: Systematic review and meta-analysis.” European journal of obstetrics, gynecology, and reproductive biology (2024). PMID: 38749071 ↗
L2aSR_OBSCited in: Special Populations - [222]
John S, Young LT, Lacro RV et al.. “Extracardiac Manifestations Fail to Predict the Severity of Cardiac Phenotype in Children and Young Adults with Marfan Syndrome.” Pediatric cardiology (2025). PMID: 38727826 ↗
L1bRCTCited in: Special Populations - [223]
Thunström S, Thunström E, Naessén S et al.. “All-cause mortality and death by aortic dissection in women with Turner syndrome: A national clinical cohort study.” American heart journal (2025). PMID: 39603484 ↗
L2bCOHORTCited in: Special Populations - [224]
Liu H, Yang L, Chen CY et al.. “Management strategies and outcomes in pregnancy-related acute aortic dissection: a multicentre cohort study in China.” Heart (British Cardiac Society) (2024). PMID: 39266045 ↗
L2bCOHORTCited in: Special Populations - [225]
Thunström S, Wide U, Landin-Wilhelmsen K et al.. “Psychiatric disorders and comorbidity in women with Turner Syndrome: a retrospective national cohort study.” Translational psychiatry (2024). PMID: 39227579 ↗
L2bCOHORTCited in: Special Populations - [226]
Samman B, Deng MX, Chung JCY et al.. “Understanding Thoracic Aortic Disease in Women.” Circulation research (2025). PMID: 40080538 ↗
L5REVIEW_NARRATIVECited in: Special Populations - [227]
. “Maternal cardiovascular morbidity and mortality associated with pregnancy in individuals with Turner syndrome: a committee opinion.” Fertility and sterility (2024). PMID: 38980250 ↗
L5REVIEW_NARRATIVECited in: Special Populations - [228]
Nariai M, Wada-Hiraike O, Sasabuchi Y et al.. “Aortic dissection during the perinatal period in women with Marfan-related disorders: a retrospective cohort study using the Japanese Diagnosis Procedure Combination database.” The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (2026). PMID: 41866242 ↗
L2bCOHORTCited in: Special Populations - [229]
Chan CH, Chow SC, Chang AT et al.. “Emergency Bentall Procedure for Acute Type A Aortic Dissection in a Patient With Preterm Twin Pregnancy.” The Annals of thoracic surgery (2025). PMID: 40466851 ↗
L4CASE_REPORTCited in: Special Populations - [230]
Wang Z, Yu X, Ding S et al.. “Management and outcomes of aortic dissection type B in late pregnancy: A retrospective case series.” BJOG : an international journal of obstetrics and gynaecology (2024). PMID: 39075929 ↗
L4CASE_REPORTCited in: Special Populations - [231]
Trajkovski AV, Reiner K, Džaja N et al.. “Anesthetic management for cesarean section in two parturient with ascending aortic aneurysm: a case-based discussion.” BMC anesthesiology (2024). PMID: 38711027 ↗
L4CASE_REPORTCited in: Special Populations - [232]
Manolis AA, Manolis TA, Vouliotis A et al.. “Ascending Aorta Aneurysm: What the Cardiologist Needs to Know.” Angiology (2026). PMID: 41919573 ↗
L5REVIEW_NARRATIVECited in: Special Populations - [233]
de Groote K, Patel SR, Mortensen KH et al.. “Management of Cardiovascular Health Issues in Turner Syndrome: Expert Insights and Expanded Recommendations From the 2024 Guideline Development Team.” American journal of medical genetics. Part C, Seminars in medical genetics (2025). PMID: 40135715 ↗
L5REVIEW_NARRATIVECited in: Special Populations - [234]
Tournoy TK, D'hulst S, Demolder A et al.. “Telomere length in patients with Marfan Syndrome.” International journal of cardiology (2026). PMID: 41679654 ↗
L5OTHERCited in: Special Populations - [235]
De Gaspari M, Basso C, Dalla Zanna F et al.. “A 4-Decade Population-Based Registry of Thoracic Aortic Dissection Causing Sudden Death in the Young.” JACC. Advances (2026). PMID: 41475307 ↗
L5OTHERCited in: Special Populations - [236]
Shrestha M, Kaufeld T, Rudolph L et al.. “Should We Replace the Non-Aneurysmal Aortic Arch During Elective Valve-Sparing Aortic Root Replacement in Marfan Patients?” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2026). PMID: 41442164 ↗
L5OTHERCited in: Special Populations - [237]
Van Der Zande JA, Grewal J, Franx A et al.. “Cardiovascular outcomes and aortic growth in pregnant women with Turner syndrome: data from the ESC EORP Registry Of Pregnancy And Cardiac disease (ROPAC) III.” European journal of preventive cardiology (2025). PMID: 40916742 ↗
L5OTHERCited in: Special Populations - [238]
Figueroa AV, Tanenbaum MT, Costa Filho JE et al.. “Landing zones optimization using transcatheter electrosurgical septotomy for endovascular repair of post-dissection aortic aneurysms.” Journal of vascular surgery (2025). PMID: 40780667 ↗
L5OTHERCited in: Special Populations - [239]
Peters PNJ, van der Zande JA, De Backer J et al.. “Pregnancy outcomes in women with heritable thoracic aortic disease: data from the EORP ESC registry of pregnancy and cardiac disease (ROPAC) III.” European heart journal. Quality of care & clinical outcomes (2025). PMID: 40576452 ↗
L5OTHERCited in: Special Populations - [240]
Bouhatous YM, Arnaud P, Jondeau G et al.. “Shprintzen-Goldberg syndrome: follow-up of the cardiovascular features in an international cohort of 29 patients with SGS.” Journal of medical genetics (2025). PMID: 40562530 ↗
L5OTHERCited in: Special Populations - [241]
Narula N, Schwartz Y, Devereux RB et al.. “Clinical and Phenotypic Correlates of Mitral Valve Prolapse in Marfan Syndrome: The Cornell Aortic Aneurysm Registry.” Journal of the American Heart Association (2025). PMID: 40357669 ↗
L5OTHERCited in: Special Populations - [242]
Soto ME, Rodríguez-Brito M, Pérez-Torres I et al.. “Analysis of FBN1, TGFβ2, TGFβR1 and TGFβR2 mRNA as Key Molecular Mechanisms in the Damage of Aortic Aneurysm and Dissection in Marfan Syndrome.” International journal of molecular sciences (2025). PMID: 40243722 ↗
L5OTHERCited in: Special Populations - [243]
Campello Jorge CA, Marway PS, Tjahjadi NS et al.. “Growth Rate Assessed by Vascular Deformation Mapping Predicts Type B Aortic Dissection in Marfan Syndrome.” Journal of the American Heart Association (2025). PMID: 40008501 ↗
L5OTHERCited in: Special Populations - [244]
Zhou X, Xu Q, Hu X et al.. “PP2A Attenuates Thoracic Aneurysm and Dissection in Mouse Models of Marfan Syndrome.” Hypertension (Dallas, Tex. : 1979) (2025). PMID: 39878024 ↗
L5OTHERCited in: Special Populations - [245]
Chen SW, Chang FC, Chen CY et al.. “Pregnancy, aortic events, and neonatal and maternal outcomes.” European heart journal (2025). PMID: 39528388 ↗
L5OTHERCited in: Special Populations - [246]
Butnariu LI, Russu G, Luca AC et al.. “Identification of Genetic Variants Associated with Hereditary Thoracic Aortic Diseases (HTADs) Using Next Generation Sequencing (NGS) Technology and Genotype-Phenotype Correlations.” International journal of molecular sciences (2024). PMID: 39456956 ↗
L5OTHERCited in: Special Populations - [247]
Thomas R, Dhanekula AS, Byers P et al.. “Elective root replacement increases the risk of type B dissection in patients with Marfan syndrome.” The Journal of thoracic and cardiovascular surgery (2025). PMID: 39326730 ↗
L5OTHERCited in: Special Populations - [248]
Claus J, Schoof L, Mir TS et al.. “Late diagnosis of Marfan syndrome is associated with unplanned aortic surgery and cardiovascular death.” The Journal of thoracic and cardiovascular surgery (2025). PMID: 39306029 ↗
L5OTHERCited in: Special Populations - [249]
Valdivia Callejon I, Buccioli L, Bastianen J et al.. “Investigation of Strategies to Block Downstream Effectors of AT1R-Mediated Signalling to Prevent Aneurysm Formation in Marfan Syndrome.” International journal of molecular sciences (2024). PMID: 38732244 ↗
L5OTHERCited in: Special Populations - [250]
Cha HJ, Kim JW, Moon SH et al.. “Lobar torsion following open surgical repair for type B aortic dissection in a patient with Marfan syndrome.” Journal of cardiothoracic surgery (2025). PMID: 41353160 ↗
L4CASE_REPORTCited in: Special Populations - [251]
Isselbacher EM, Preventza O, Hamilton Black J et al.. “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.” Circulation (2022). PMID: 36322642 ↗
L1cGUIDELINECited in: Guidelines and Resources - [252]
Isselbacher EM, Preventza O, Hamilton Black Iii J et al.. “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.” Journal of the American College of Cardiology (2022). PMID: 36334952 ↗
L1cGUIDELINECited in: Guidelines and Resources - [253]
Isselbacher EM, Preventza O, Hamilton Black J et al.. “2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.” The Journal of thoracic and cardiovascular surgery (2023). PMID: 37389507 ↗
L1cGUIDELINECited in: Guidelines and Resources - [254]
Lombardi JV, Hughes GC, Appoo JJ et al.. “Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections.” Journal of vascular surgery (2020). PMID: 32001058 ↗
L1cGUIDELINECited in: Guidelines and Resources - [255]
Kicska GA, Hurwitz Koweek LM, Ghoshhajra BB et al.. “ACR Appropriateness Criteria® Suspected Acute Aortic Syndrome.” Journal of the American College of Radiology : JACR (2021). PMID: 34794601 ↗
L1cGUIDELINECited in: Guidelines and Resources - [256]
Wanhainen A, Gombert A, Antoniou GA et al.. “European Society for Vascular Surgery (ESVS) 2026 Clinical Practice Guidelines on the Management of Descending Thoracic and Thoraco-Abdominal Aortic Diseases - Editor's Choice.” European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (2026). PMID: 41448425 ↗
L1cGUIDELINECited in: Guidelines and Resources - [257]
Bradley TJ, Alvarez NA, Horne SG. “A Practical Guide to Clinical Management of Thoracic Aortic Disease.” The Canadian journal of cardiology (2016). PMID: 26724515 ↗
L1cGUIDELINECited in: Guidelines and Resources - [258]
Hiratzka LF, Creager MA, Isselbacher EM et al.. “Surgery for aortic dilatation in patients with bicuspid aortic valves: A statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” The Journal of thoracic and cardiovascular surgery (2016). PMID: 26995623 ↗
L1cGUIDELINECited in: Guidelines and Resources - [259]
Hiratzka LF, Creager MA, Isselbacher EM et al.. “Surgery for Aortic Dilatation in Patients With Bicuspid Aortic Valves: A Statement of Clarification From the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Journal of the American College of Cardiology (2016). PMID: 26658475 ↗
L1cGUIDELINECited in: Guidelines and Resources - [260]
Sheeran DP, Tong RT, Khaja MS et al.. “ACR Appropriateness Criteria® Abdominal Aortic Aneurysm or Dissection-Interventional Planning and Follow-Up: Update 2025.” Journal of the American College of Radiology : JACR (2026). PMID: 41837923 ↗
L1cGUIDELINECited in: Guidelines and Resources - [261]
Hiratzka LF, Creager MA, Isselbacher EM et al.. “Surgery for Aortic Dilatation in Patients With Bicuspid Aortic Valves: A Statement of Clarification From the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Circulation (2016). PMID: 26637530 ↗
L1cGUIDELINECited in: Guidelines and Resources - [262]
Johansen KL, Garimella PS, Hicks CW et al.. “Central and peripheral arterial diseases in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.” Kidney international (2021). PMID: 33961868 ↗
L1cGUIDELINECited in: Guidelines and Resources - [263]
. “Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome.” Fertility and sterility (2006). PMID: 17055808 ↗
L1cGUIDELINECited in: Guidelines and Resources - [264]
Verma R, Cohen G, Colbert J et al.. “Bicuspid aortic valve associated aortopathy: 2022 guideline update.” Current opinion in cardiology (2023). PMID: 36718616 ↗
L1cGUIDELINECited in: Guidelines and Resources - [265]
Seki Y, Okamoto K, Ikezoe T et al.. “Clinical practice guidelines for management of disseminated intravascular coagulation in Japan 2024. Part 3: solid cancers and vascular abnormalities.” International journal of hematology (2025). PMID: 39792236 ↗
L1cGUIDELINECited in: Guidelines and Resources - [266]
Eggebrecht H. “[Diagnosis and treatment of aortic diseases : new guidelines of the European Society of Cardiology 2014].” Herz (2014). PMID: 25406331 ↗
L1cGUIDELINECited in: Guidelines and Resources - [267]
Bruyère M, Morau E, Beaumont É et al.. “[Maternal mortality due to cardiovascular disease in France 2013-2015].” Gynecologie, obstetrique, fertilite & senologie (2021). PMID: 33161192 ↗
L1cGUIDELINECited in: Guidelines and Resources - [268]
Gao H, Liu X, Wang Y et al.. “Aortic root dilation in bicuspid aortic valve disease: impact on dissection risk and evaluation of guideline-based surgical thresholds - a retrospective cohort study.” International journal of surgery (London, England) (2025). PMID: 40479495 ↗
L2bCOHORTCited in: Guidelines and Resources - [269]
Pak KJ, Hu T, Fee C et al.. “Acute hypertension: a systematic review and appraisal of guidelines.” Ochsner journal (2014). PMID: 25598731 ↗
L2aSR_OBSCited in: Guidelines and Resources - [270]
Duijnhouwer A, van den Hoven A, Merkx R et al.. “Differences in Aortopathy in Patients with a Bicuspid Aortic Valve with or without Aortic Coarctation.” Journal of clinical medicine (2020). PMID: 31972995 ↗
L5OTHERCited in: Guidelines and Resources - [271]
Seferović PM, Ristić AD, Maksimović R et al.. “Pericardial syndromes: an update after the ESC guidelines 2004.” Heart failure reviews (2013). PMID: 22855353 ↗
L5REVIEW_NARRATIVECited in: Guidelines and Resources - [272]
Sprynger M, Rigo F, Moonen M et al.. “Focus on echovascular imaging assessment of arterial disease: complement to the ESC guidelines (PARTIM 1) in collaboration with the Working Group on Aorta and Peripheral Vascular Diseases.” European heart journal. Cardiovascular Imaging (2018). PMID: 30239635 ↗
L5OTHERCited in: Guidelines and Resources - [273]
Mariucci EM, Lovato L, Rosati M et al.. “Dilation of peripheral vessels in Marfan syndrome: importance of thoracoabdominal MR angiography.” International journal of cardiology (2013). PMID: 22954416 ↗
L5OTHERCited in: Guidelines and Resources - [274]
Lorenz V, Muzzi L, Neri E. “Should the DeBakey Classification Be Reconsidered for Acute Type A Aortic Dissection?” The Annals of thoracic surgery (2026). PMID: 42413682 ↗
L3bCited in: Definition, Synonyms, and Classification - [275]
Xin Y, Lyu S, Wang J et al.. “Predictive value of inflammatory indexes in in-hospital mortality for patients with acute aortic dissection.” BMC cardiovascular disorders (2025). PMID: 40281397 ↗
L3bCited in: Definition, Synonyms, and Classification - [276]
Liu HH, Chang CB, Chen YS et al.. “Automated Detection and Differentiation of Stanford Type A and Type B Aortic Dissections in CTA Scans Using Deep Learning.” Diagnostics (Basel, Switzerland) (2024). PMID: 39795540 ↗
L3bCited in: Definition, Synonyms, and Classification - [277]
Lin CY, Tung TH, Wu MY et al.. “Surgical outcomes of DeBakey type I and type II acute aortic dissection: a propensity score-matched analysis in 599 patients.” Journal of cardiothoracic surgery (2021). PMID: 34330304 ↗
L3bCited in: Definition, Synonyms, and Classification - [278]
Tien M, Ku A, Martinez-Acero N et al.. “The Penn Classification Predicts Hospital Mortality in Acute Stanford Type A and Type B Aortic Dissections.” Journal of cardiothoracic and vascular anesthesia (2019). PMID: 31558394 ↗
L4Cited in: Definition, Synonyms, and Classification - [279]
Halabi M, Ding J, Salim S et al.. “Equipoise: The basic necessity for conducting a trial on uncomplicated Type B aortic dissection.” Seminars in vascular surgery (2026). PMID: 42285636 ↗
L1bCited in: Etiology and Triggering Factors - [280]
Yassa ES, Fitzpatrick N, Shalhub S et al.. “The rationale for a randomized trial for uncomplicated Type B aortic dissection.” Seminars in vascular surgery (2026). PMID: 42285635 ↗
L1bCited in: Etiology and Triggering Factors - [281]
Yokouchi-Konishi T, Aoki-Kamiya C, Tsuritani M et al.. “The impact of FBN1 variant types on pregnancy-related aortic dissection in women with Marfan syndrome.” International journal of cardiology (2026). PMID: 42314848 ↗
L2bCited in: Etiology and Triggering Factors - [282]
Semań T, Krupa-Nurcek S, Szczupak M et al.. “Sarcopenia as a Prognostic Marker of Early Mortality After Surgery for Acute Aortic Dissection: A Prospective Cohort Study.” Medical sciences (Basel, Switzerland) (2026). PMID: 42029601 ↗
L2bCited in: Etiology and Triggering Factors - [283]
Ji Y, Zhou C, Zhang K et al.. “Impact of Intimal Tear Location on Clinical Outcomes in Extensive Arch Repair of Acute Stanford Type A Aortic Dissection.” Journal of the American Heart Association (2026). PMID: 42396809 ↗
L3bCited in: Etiology and Triggering Factors - [284]
Yamashita G, Yaegashi K, Takauchi T et al.. “Proximal Anastomotic New Entry Tear Following Surgical Repair of Acute Type A Aortic Dissection: Anatomical Location, Risk Factors, and Impact on Long-Term Outcomes.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2026). PMID: 41934622 ↗
L3bCited in: Etiology and Triggering Factors - [285]
Nakayama T, Kaneko H, Suzuki Y et al.. “Association of Autosomal Dominant Polycystic Kidney Disease With Incident Aortic Dissection or Aneurysm.” American journal of kidney diseases : the official journal of the National Kidney Foundation (2026). PMID: 41881380 ↗
L3bCited in: Etiology and Triggering Factors - [286]
Tanaka K, Akutsu K, Miyata S et al.. “What Is the Most Influential Factor Affecting Severe Respiratory Failure in Uncomplicated Acute Type B Aortic Dissection?” Circulation journal : official journal of the Japanese Circulation Society (2026). PMID: 41621970 ↗
L4Cited in: Etiology and Triggering Factors - [287]
Kurniawan K, Wartono DA. “Operative predictors of mortality and neurologic outcomes after modified Bentall for acute aortic dissection: A systematic review and meta-analysis.” Asian cardiovascular & thoracic annals (2026). PMID: 42060530 ↗
L2aCited in: Etiology and Triggering Factors - [288]
Fernandes Pedro J, Figueiredo ARM, Almeida R et al.. “Growth rate of the ascending aorta and risk of aortic dissection or reintervention in patients with bicuspid or tricuspid aortic valves undergoing valve interventions: A systematic review and meta-analysis.” Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology (2026). PMID: 41932606 ↗
L2aCited in: Etiology and Triggering Factors - [289]
Gu T, Zhang Y, Li G et al.. “Association of 3-Day Postoperative Blood Glucose Variability With All-Cause Mortality in ICU Patients After Surgical Repair of Acute Type A Aortic Dissection: A Retrospective Cohort Study Using the MIMIC-IV Database.” Clinical cardiology (2026). PMID: 42296074 ↗
L3bCited in: Etiology and Triggering Factors - [290]
Arar M, Beckmann E, Martens A et al.. “The impact of emergency intubation on surgical outcomes in patients with acute aortic dissection AADA (DeBakey I). Is a prompt treatment justified?” Journal of cardiothoracic surgery (2026). PMID: 42265728 ↗
L3bCited in: Etiology and Triggering Factors - [291]
Becker D, Frenzer C, Messerli M et al.. “Baseline Descending Aortic Diameter Drives Long-Term Failure of Conservative Management in Uncomplicated Type B Aortic Dissection.” Annals of vascular surgery (2026). PMID: 42103141 ↗
L4Cited in: Etiology and Triggering Factors - [292]
Zhang B, Gao F, Wang J et al.. “A patient-specific CTA-CFD framework deciphers hemodynamic heterogeneity after fenestrated TEVAR: a pilot study.” Frontiers in bioengineering and biotechnology (2026). PMID: 42339463 ↗
L4Cited in: Pathophysiology - [293]
Dushfunian D, Berhane H, Johnson E et al.. “CE-MRA-FLOWnet: Fast and Accurate Generative AI-Based Aortic Hemodynamic Mapping from Contrast-Enhanced MRA.” Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance (2026). PMID: 42413872 ↗
L3bCited in: Pathophysiology - [294]
Lin Y, Lv XC, Cai ZW et al.. “Medial Neovascularization: A Novel Mechanism of Aortic Dissection in a Hypertensive Population?” Journal of the American Heart Association (2026). PMID: 42216260 ↗
L4Cited in: Pathophysiology - [295]
Recchioni T, Manzi G, Caputo A et al.. “Sodium nitroprusside: A comprehensive systematic review of its role across various clinical settings.” Vascular pharmacology (2026). PMID: 41903872 ↗
L1aCited in: Pathophysiology - [296]
Zimmermann WH, Ensminger S, Kutschka I et al.. “Stem-Cell-Derived Biologic Ventricular Assist Tissue in Heart Failure.” The New England journal of medicine (2026). PMID: 42202318 ↗
L4Cited in: Pathophysiology - [297]
Lu W, Cao L, Luan S et al.. “Association Between Aortic Calcification and Primary Intimal Tear in Type B Aortic Dissection.” Annals of vascular surgery (2025). PMID: 41207531 ↗
L3bCited in: Pathophysiology - [298]
Johnson C, Shalhub S, Cheema M et al.. “How ominous are persistent pain and hypertension for uncomplicated Type B aortic dissections?” Seminars in vascular surgery (2026). PMID: 42285639 ↗
L4Cited in: Pathophysiology - [299]
Franklin MK, Howatt DA, Moorleghen JJ et al.. “Angiotensin II Induces Abdominal Aortic Branch Aneurysms in Fibrillin-1 C1041G/+ Mice-Brief Report.” Arteriosclerosis, thrombosis, and vascular biology (2026). PMID: 42206371 ↗
L5Cited in: Pathophysiology - [300]
Bosshardt D, Merton R, Nederveen AJ et al.. “Aortic displacement and hemodynamics are abnormal in patients with Marfan syndrome: A combined four-dimensional balanced steady-state free precession and four-dimensional flow cardiac magnetic resonance study.” Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance (2026). PMID: 42019568 ↗
L5Cited in: Pathophysiology - [301]
Bosshardt D, Merton R, Schrauben EM et al.. “Assessing changes in aortic motion and hemodynamics after valve-sparing aortic root surgery in Marfan syndrome using four-dimensional balanced steady-state free precession and four-dimensional flow cardiovascular magnetic resonance.” Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance (2026). PMID: 42001956 ↗
L5Cited in: Pathophysiology - [302]
Huang H, Ming Z, Gu W et al.. “Preoperative exercise tolerance, nutritional-inflammatory markers, and outcomes after TEVAR for type B aortic pathology.” Frontiers in cardiovascular medicine (2026). PMID: 42344365 ↗
L3bCited in: Clinical Features and Variants - [303]
De León Ayala IA, Cheng YT, Liu TT et al.. “Operative and hemostatic differences between acute type A intramural hematoma and aortic dissection.” Surgery (2026). PMID: 42134071 ↗
L3bCited in: Clinical Features and Variants - [304]
de Kort JF, Mandigers TJ, Jabbour G et al.. “Endovascular repair of the ascending aorta in the Vascular Quality Initiative.” Journal of vascular surgery (2025). PMID: 40633789 ↗
L4Cited in: Clinical Features and Variants - [305]
Du P, Liu X, Zheng Q et al.. “Real-time identification of aetiology in patients able to undergo transoesophageal echocardiography with non-traumatic out-of-hospital cardiac arrest in China: a prospective, single-centre exploratory study.” Emergency medicine journal : EMJ (2026). PMID: 42315321 ↗
L4Cited in: Differential Diagnosis - [306]
Ketsekioulafis I, Katsos K, Zouzia E et al.. “Civil Medical Liability in Cardiology: A Systematic Review.” Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese (2026). PMID: 42413578 ↗
L2aCited in: Differential Diagnosis - [307]
Fukano K, Sasabuchi Y, Matsui H et al.. “Nationwide trends in outcomes and resource utilization in surgically treated acute type A aortic dissection with coronary malperfusion.” JTCVS open (2026). PMID: 42381934 ↗
L3bCited in: Differential Diagnosis - [308]
Lin H, Sun Q, Yao W et al.. “Fear of movement and its associated psychosocial factors in patients with acute cardiovascular disease: a retrospective cohort study.” BMC cardiovascular disorders (2026). PMID: 41975277 ↗
L3bCited in: Differential Diagnosis - [309]
He B, Zheng X, Zhao Q et al.. “Debranching with thoracic endovascular aortic repair for treating aortic arch lesions: a retrospective single-center experience.” Journal of thoracic disease (2026). PMID: 41816383 ↗
L4Cited in: Differential Diagnosis - [310]
Yan L, Zhao C, Duojie D et al.. “Prognostic value of isolated left vertebral artery in acute type A aortic dissection patients.” BMC cardiovascular disorders (2026). PMID: 41501647 ↗
L3bCited in: Differential Diagnosis - [311]
Inomata T, Nakaya K, Shiozaki H et al.. “Necessity of whole-body CT in patients with acute ischemic stroke and proposal for a simple brain perfusion imaging and whole-body CT protocol using split-bolus injection.” Emergency radiology (2025). PMID: 41449297 ↗
L4Cited in: Differential Diagnosis - [312]
Cerqueira RJ, Mascarenhas JQ, Rodrigues M et al.. “Outcomes of Aortic Valve Repair: A Systematic Review and Meta-Analysis Using Reconstructed Individual Patient Data.” Innovations (Philadelphia, Pa.) (2026). PMID: 42116530 ↗
L1aCited in: Supportive Care and Complication Management - [313]
Chen H, Wu C, Chen Y et al.. “Early Prone Positioning After Acute Type A Aortic Dissection Surgery for Moderate-to-Severe Acute Respiratory Distress Syndrome Is Safe and Shortens Duration of Mechanical Ventilation.” Critical care explorations (2026). PMID: 42249540 ↗
L2bCited in: Supportive Care and Complication Management - [314]
Ramkaran R, Briscoe J, Cameron DE et al.. “Rupture and dissection of aortic autograft following the ross procedure: a systematic review.” Journal of cardiothoracic surgery (2026). PMID: 41803948 ↗
L4Cited in: Supportive Care and Complication Management - [315]
Xu Y, Huang C, Wang Y et al.. “Machine learning prediction of postoperative acute kidney injury in aortic dissection patients using dynamic inflammatory markers and clinical features.” BMC medical informatics and decision making (2026). PMID: 41882706 ↗
L3bCited in: Supportive Care and Complication Management - [316]
Aichi C, Inagaki M, Yanagisawa J et al.. “Mid-term outcomes of trans-axillary versus thoracotomy approaches in alternative-access tavr: a retrospective multicenter study.” Cardiovascular intervention and therapeutics (2026). PMID: 41762413 ↗
L3bCited in: Supportive Care and Complication Management - [317]
Wen J, Zheng W, Sun L et al.. “A Pilot Serum Metabolomics Reveals Mitochondrial Dysfunction and Identifies Methylguanidine as a Potential Diagnostic Biomarker for ATAAD with Mesenteric Malperfusion Syndrome.” Metabolites (2026). PMID: 42042885 ↗
L4Cited in: Supportive Care and Complication Management - [318]
. “[Expert consensus on diagnosis and treatment of acute aortic dissection with malperfusion syndrome (2026 edition)].” Zhonghua wai ke za zhi [Chinese journal of surgery] (2026). PMID: 41771516 ↗
L1cCited in: Supportive Care and Complication Management - [319]
Lu S, Xu A, Jiang Y et al.. “Development and validation of a nomogram-based risk prediction model for postoperative delirium in patients with stanford type A aortic dissection.” Journal of cardiothoracic surgery (2026). PMID: 41933412 ↗
L3bCited in: Supportive Care and Complication Management - [320]
de Kort JF, Hasami NA, Been M et al.. “Trends and Updates in the Management and Outcomes of Acute Uncomplicated Type B Aortic Dissection.” Annals of vascular surgery (2025). PMID: 39855380 ↗
L1bCited in: Landmark Trials and Key Evidence - [321]
Lian T, Pai CW, Woznicki E et al.. “Nonsyndromic familial type B aortic dissection exhibits distinct clinical profiles and operative outcomes.” Journal of vascular surgery (2026). PMID: 42082039 ↗
L3bCited in: Landmark Trials and Key Evidence - [322]
Braverman AC, Mittauer E, Harris KM et al.. “Clinical Features and Outcomes of Pregnancy-Related Acute Aortic Dissection.” JAMA cardiology (2021). PMID: 33052376 ↗
L3bCited in: Landmark Trials and Key Evidence - [323]
Parikh N, Trimarchi S, Gleason TG et al.. “Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program.” The Journal of thoracic and cardiovascular surgery (2017). PMID: 28168983 ↗
L4Cited in: Landmark Trials and Key Evidence - [324]
Bojko MM, Suhail M, Bavaria JE et al.. “Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians.” The Journal of thoracic and cardiovascular surgery (2020). PMID: 32624307 ↗
L3bCited in: Landmark Trials and Key Evidence - [325]
Sharma VJ, Kang M, Ganesh JS et al.. “Can We Better Differentiate Type A Dissections: Evaluating the Role of Aortic Ratios.” Heart, lung & circulation (2022). PMID: 35597706 ↗
L3bCited in: Landmark Trials and Key Evidence - [326]
Chaddha A, Erickson S, Kline-Rogers E et al.. “Medication adherence patterns in aortic dissection survivors.” The Indian journal of medical research (2018). PMID: 29806607 ↗
L4Cited in: Landmark Trials and Key Evidence