Dissections of the Thoracic Aorta and Evolving Endovascular Strategies

Acute dissection is the most common life threatening condition of the aorta affecting 5-30 per million people per year [1]. Left untreated, the majority of patients with dissections involving the ascending aorta will die within days of an acute episode [2]. Patients presenting with descending thoracic aortic dissections seem to fare better, with one in ten patients dying before leaving hospital. Ultimately, these patients are at risk of aortic rupture with nearly 20% of these patients requiring some form of surgical or endovascular intervention [3]. Judicious medical, surgical and endovascular management of this condition aims to reduce propagation of the dissection plane and concomitant branch vessel compromise, halt aortic expansion and prevent fatal aortic rupture. Early recognition of these disease entities in conjunction with urgent and pertinent management is the key to a successful outcome in these patients.