Patients who present without pain are more likely to have a missed or delayed diagnosis 17. Patients with narrowed pulse pressure experienced more cardiac complications, particularly cardiac tamponade, whereas those with markedly elevated pulse pressure were more likely to have abdominal aortic involvement 16.ĭiagnosis of this disease requires a high degree of suspicion of an aortic dissection in patients who have some risk factors.

Hypertension is the most common condition associated with AAD, although in time of presentation is more frequent in type B than in type A (70% vs 36 %). These patients had a higher rate of in-hospital complications 15. Pulse deficits were described in 30% and 20% of patients with a type A and type B dissection, respectively 14. Syncope was reported in 13%, often indicating a severe haemodynamic status, obstruction of cerebral vessels or stroke 13. Patients with abdominal pain tended to have delayed diagnosis and had experienced a higher mortality rate than those with more typical symptoms (28% vs 10%, p=0.02) 12. Chest pain was significantly more common in patients with type A AAD (79% versus 63% of type B dissections), whereas back pain and abdominal pain were more common in type B AAD (64% and 43%, respectively) 1. However, tearing, ripping or migratory were not common descriptors of pain in IRAD. Sudden onset of severe, sharp pain was the single most common presenting complaint. Therefore, the current surgical guidelines for thoracic aortic aneurysm repair (<5.5 cm) would fail to prevent the majority of AAD seen in this cohort ( Figure 2) 7. Marfan syndrome patients were more likely to dissect at larger diameters (odds ratio, 14.3 p<0.002). Although aorta dilation is a well-established risk factor for AAD, an interesting finding of the registry was that 60% of patients had maximum aortic diameters <5.5 cm and 40% patients aortic diameters <5.0 cm. A history of atherosclerosis was present in 31% of patients and a history of heart surgery in 18% 6. Younger patients (< 40 years of age) were less likely to have a history of hypertension (34%) or atherosclerosis (1%) but more likely to have Marfan’s syndrome and bicuspid aortic valve (59 %) 5.

In the total registry, 5% and 4% of AAD were thought to be related to Marfan’s syndrome and iatrogenic causes, respectively 3 and cocaine use in 1.8% 4. The most common predisposing factor in the IRAD was hypertension (72%). There are many risk conditions related to aortic dissection. Women were older than men, with a mean age of 67 years (p=0.008) 2. In the IRAD series, two thirds of included patients were male, with a mean age for all patients of 63 years.

Irad 200