Materiały źródłowe

• #1

  https://journals.lww.com/cardioplus/fulltext/2022/12000/aortic_dissection__global_epidemiology.1.aspx

  Aortic dissection is a highly fatal disease with limited predictability requiring emergency response. It remains a challenging clinical problem and has a reported lower 5-year survival rate, especially in acute cases. Studying the epidemiology of aortic dissection can be important for targeting key populations and developing public health policies. […] The reported prevalence of aortic dissection after autopsy is as much as 1% to 3% and the annual incidence rate of type A aortic dissection is roughly 3/100,000. […] The mortality rate is approximately 1% per hour initially and 50% by the third day for untreated aortic dissection. […] A 20-year national study showed a significant decrease in in-hospital mortality for type A but not for such a trend was not seen for type B. […] In the past, the research and application of the epidemiology of aortic dissection have focused on in-hospital and follow-up mortality. Incidence data have rarely been generated or provided.

• #2 Epidemiology of aortic dissection – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33757630/

  Aortic dissection remains a highly morbid diagnosis. […] However, despite the robust research in treatment, the epidemiology of aortic dissection is limited. […] We review the trends in incidence during the past 40 years, with consideration for sex, race, and ethnicity in admission. […] Care for those with aortic dissection remains a long-term challenge for providers and a multispecialty approach is needed for complete patient management.

• #3

  https://journals.lww.com/cardioplus/fulltext/2022/12000/aortic_dissection__global_epidemiology.1.aspx

  Aortic dissection is a highly fatal disease with limited predictability requiring emergency response. It remains a challenging clinical problem and has a reported lower 5-year survival rate, especially in acute cases. Studying the epidemiology of aortic dissection can be important for targeting key populations and developing public health policies. […] The reported prevalence of aortic dissection after autopsy is as much as 1% to 3% and the annual incidence rate of type A aortic dissection is roughly 3/100,000. […] The mortality rate is approximately 1% per hour initially and 50% by the third day for untreated aortic dissection. […] A 20-year national study showed a significant decrease in in-hospital mortality for type A but not for such a trend was not seen for type B. […] In the past, the research and application of the epidemiology of aortic dissection have focused on in-hospital and follow-up mortality. Incidence data have rarely been generated or provided.

• #4 Aortic Dissection: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2062452-overview

  In the United States, aortic dissection is an uncommon disease. The true frequency of aortic dissection is difficult to estimate, and most estimates are based on autopsy studies. Evidence of aortic dissection is found in 1-3% of all autopsies (1 in 350 cadavers). The incidence of aortic dissection is estimated to be 5-30 cases per 1 million people per year. Aortic dissection occurs once per 10,000 patients admitted to the hospital; approximately 2000 new cases are reported each year in the United States. […] Aortic dissection is more common in blacks than in whites and is less common in Asians than in whites. Also, it is more common in males than females, with a male-to-female ratio of 2-3:1. […] Approximately 75% of dissections occur in those aged 40-70 years, with a peak in the range of 50-65 years. Patients with Marfan syndrome present earlier, usually in the third and fourth decades of life.

• #5 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  Acute aortic dissection is a rare but life-threatening condition, with an incidence of 5 to 30 cases per 1 million people per year. This contrasts sharply with acute myocardial infarction, which has approximately 4400 cases per 1 million people annually. Aortic dissection accounts for 3 out of every 1000 emergency department presentations involving acute chest, back, or abdominal pain. The condition predominantly affects individuals between 40 and 70, with most cases occurring in patients aged 50 to 65. Approximately 75% of dissections happen in this age range, highlighting age as a key risk factor. […] While men are 3 times more likely to develop aortic dissection than women, women often present later in the disease course and have worse outcomes. The risk profile differs between older and younger patients: older patients are more likely to have hypertension, atherosclerosis, prior aortic aneurysm, or iatrogenic dissection, while younger patients, particularly those younger than 40, are more likely to have connective tissue disorders like Marfan syndrome. Type A dissections involving the ascending aorta are twice as common as type B dissections and are more likely to be fatal without urgent intervention. Hypertension is the most prevalent modifiable risk factor, present in about 75% of patients, while other risk factors include atherosclerosis, connective tissue disorders, and previous cardiac surgery.

• #6 Epidemiology of Acute Aortic Dissection in a General Population of 1.4 Million People in Japan　― Shiga Stroke and Heart Attack Registry ―

  https://www.jstage.jst.go.jp/article/circj/87/9/87_CJ-22-0758/_html/-char/en

  Vascular Disease Epidemiology of Acute Aortic Dissection in a General Population of 1.4 Million People in Japan Shiga Stroke and Heart Attack Registry Yosuke Higo, Yuichi Sawayama, Naoyuki Takashima, Akiko Harada, Yuichiro Yano, Takashi Yamamoto, Wataru Shioyama, Takako Fujii, Sachiko Tanaka-Mizuno, Yoshikuni Kita, Katsuyuki Miura, Kazuhiko Nozaki, Tomoaki Suzuki, Yoshihisa Nakagawa Author information […] Background: Acute aortic dissection (AAD) is a life-threatening cardiovascular disease, with a reported incidence rate ranging from 2.5 to 7.2 per 100,000 person-years in several population-based registries in Western countries, but epidemiological data are lacking in Japan. […] The incidence rates of AAD were calculated by age categories and adjusted using standard populations for comparison. A total of 402 incident cases with AAD were analyzed. The age-adjusted incidence rates using the 2015 Japanese population and the 2013 European Standard Population were 15.8 and 12.2 per 100,000 person-years, respectively.

• #7

  https://journals.lww.com/cardioplus/fulltext/2022/12000/aortic_dissection__global_epidemiology.1.aspx

  The incidence of type A and type B aortic dissection reported by the Federal Statistical Office of Germany and the emergency department in Berlin was 5.7/100,000 and 5.24/100,000, respectively. […] In North America, data from Ontario, Canada, showed a prevalence of type A and B for 4.6/100,000. Data from Medicare beneficiaries in the United States in 2010-2011 indicated that the overall hospitalization rate for type A and B aortic dissection was 10/100,000. […] In Asia, data from China Health Insurance Research supported an estimated 2.8/100,000 incidence of any types of aortic dissection. […] Importantly, the incidence of aortic dissection cannot be precisely estimated because of pre-hospital death and differing autopsy rates across the world. […] The overall incidence is shown in Table 1 and depicted as a global incidence map in Figure 1.

• #8 Epidemiology of Acute Aortic Dissection in a General Population of 1.4 Million People in Japan　― Shiga Stroke and Heart Attack Registry ―

  https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-22-0758/_html/-char/en

  Epidemiology of Acute Aortic Dissection in a General Population of 1.4 Million People in Japan Shiga Stroke and Heart Attack Registry Yosuke Higo, Yuichi Sawayama, Naoyuki Takashima, Akiko Harada, Yuichiro Yano, Takashi Yamamoto, Wataru Shioyama, Takako Fujii, Sachiko Tanaka-Mizuno, Yoshikuni Kita, Katsuyuki Miura, Kazuhiko Nozaki, Tomoaki Suzuki, Yoshihisa Nakagawa Author information […] Acute aortic dissection (AAD) is a life-threatening cardiovascular disease, with a reported incidence rate ranging from 2.5 to 7.2 per 100,000 person-years in several population-based registries in Western countries, but epidemiological data are lacking in Japan. […] The age-adjusted incidence rates using the 2015 Japanese population and the 2013 European Standard Population were 15.8 and 12.2 per 100,000 person-years, respectively.

• #9 Epidemiology of Acute Aortic Dissection in a General Population of 1.4 Million People in Japan　― Shiga Stroke and Heart Attack Registry ―

  https://www.jstage.jst.go.jp/article/circj/87/9/87_CJ-22-0758/_html/-char/en

  Population-based incidence rates of AAD in Japan appear to be higher than in previous reports from Western countries. […] The purpose of the present study was to elucidate the incidence of AAD in Japan on the basis of a large-scale, population-based registry, using out-of-hospital death information in addition to medical record data. […] The Shiga Stroke and Heart Attack Registry (SSHR) is an ongoing multicenter population-based registry study designed to provide a comprehensive information system for the management of cerebrovascular disease, including stroke, acute coronary syndrome, and acute aortic disease in Shiga Prefecture, Japan. […] The crude incidence rate of AAD in Shiga Prefecture was 14.3 per 100,000 person-years. The incidence rate of AAD increased with age, and was highest among those aged 85 years, with an incidence of 96.0 per 100,000 person-years.

• #10 Epidemiology of Acute Aortic Dissection in a General Population of 1.4 Million People in Japan　― Shiga Stroke and Heart Attack Registry ―

  https://www.jstage.jst.go.jp/article/circj/87/9/87_CJ-22-0758/_html/-char/en

  The age-adjusted incidence rates of AAD using the 2015 Japanese population and the 2013 European Standard Population were 15.8 and 12.2 per 100,000 person-years, respectively. […] Our results revealed 2 main findings. First, the age-adjusted incidence rate of AAD using the 2015 Japanese population was 15.8 per 100,000 person-years. Second, the characteristics of incident cases of type A-AAD and type B-AAD were significantly different. […] Several population-based studies have reported incidence rates of AAD. Japan has one of the oldest national populations in the world, resulting in a tendency for higher age-adjusted incidence rates when using the Japanese population as the standard. […] The reason for the higher incidence rate of AAD in Japan compared with Western countries is currently unclear. One possible reason is that the prevalence of hypertension in Japan is higher than that in most Western countries.

• #11 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  Acute aortic dissection is a rare but life-threatening condition, with an incidence of 5 to 30 cases per 1 million people per year. This contrasts sharply with acute myocardial infarction, which has approximately 4400 cases per 1 million people annually. Aortic dissection accounts for 3 out of every 1000 emergency department presentations involving acute chest, back, or abdominal pain. The condition predominantly affects individuals between 40 and 70, with most cases occurring in patients aged 50 to 65. Approximately 75% of dissections happen in this age range, highlighting age as a key risk factor. […] While men are 3 times more likely to develop aortic dissection than women, women often present later in the disease course and have worse outcomes. The risk profile differs between older and younger patients: older patients are more likely to have hypertension, atherosclerosis, prior aortic aneurysm, or iatrogenic dissection, while younger patients, particularly those younger than 40, are more likely to have connective tissue disorders like Marfan syndrome. Type A dissections involving the ascending aorta are twice as common as type B dissections and are more likely to be fatal without urgent intervention. Hypertension is the most prevalent modifiable risk factor, present in about 75% of patients, while other risk factors include atherosclerosis, connective tissue disorders, and previous cardiac surgery.

• #12 Aortic Dissection: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2062452-overview

  In the United States, aortic dissection is an uncommon disease. The true frequency of aortic dissection is difficult to estimate, and most estimates are based on autopsy studies. Evidence of aortic dissection is found in 1-3% of all autopsies (1 in 350 cadavers). The incidence of aortic dissection is estimated to be 5-30 cases per 1 million people per year. Aortic dissection occurs once per 10,000 patients admitted to the hospital; approximately 2000 new cases are reported each year in the United States. […] Aortic dissection is more common in blacks than in whites and is less common in Asians than in whites. Also, it is more common in males than females, with a male-to-female ratio of 2-3:1. […] Approximately 75% of dissections occur in those aged 40-70 years, with a peak in the range of 50-65 years. Patients with Marfan syndrome present earlier, usually in the third and fourth decades of life.

• #13 Aortic dissection epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Aortic_dissection_epidemiology_and_demographics

  The incidence of aortic dissection is approximately 6 per 100,000 individuals worldwide. […] The incidence of aortic dissection increases with age, with a mean age of 63 years. […] There is no racial predilection to aortic dissection. However, non-white race is associated with worse prognosis. […] Men are more commonly affected by aortic dissection than women. However, the prognosis tends to be worse in women due to unusual presentations. […] The 30-days mortality rate of aortic dissection type A and B is approximately 47% and 13%, respectively.

• #14

  https://journals.lww.com/cardioplus/fulltext/2022/12000/aortic_dissection__global_epidemiology.1.aspx

  The significant differences observed in serum markers require further discussion and were generally more common in older patients compared with younger patients. […] The incidence of male aortic dissection patients was nearly 61.5% in Australia, 56.0% to 65.0% in Canada and the United States, 67.1% in the IRAD study, and 67.6% in North Europe. […] The incidence of aortic dissection has risen sharply in the older adult population and is reported to be 8.6/100,000 in ages 60 to 80 years and 32/100,000 for people aged over 80 years. […] Studies have reported that operated type A aortic dissection cases in Japan are 27.2 per million persons annually, more than four times higher than in Western countries including the United States and European countries. […] The incidence of aortic dissection during pregnancy was approximately 1.45/100,000 and the condition appeared in approximately 20% of maternal cardiac deaths. […] Although the incidence of aortic dissection remains relatively stable globally, transportation and key population screening still need considerable improvement, especially in developing countries.

• #15 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  Acute aortic dissection is a rare but life-threatening condition, with an incidence of 5 to 30 cases per 1 million people per year. This contrasts sharply with acute myocardial infarction, which has approximately 4400 cases per 1 million people annually. Aortic dissection accounts for 3 out of every 1000 emergency department presentations involving acute chest, back, or abdominal pain. The condition predominantly affects individuals between 40 and 70, with most cases occurring in patients aged 50 to 65. Approximately 75% of dissections happen in this age range, highlighting age as a key risk factor. […] While men are 3 times more likely to develop aortic dissection than women, women often present later in the disease course and have worse outcomes. The risk profile differs between older and younger patients: older patients are more likely to have hypertension, atherosclerosis, prior aortic aneurysm, or iatrogenic dissection, while younger patients, particularly those younger than 40, are more likely to have connective tissue disorders like Marfan syndrome. Type A dissections involving the ascending aorta are twice as common as type B dissections and are more likely to be fatal without urgent intervention. Hypertension is the most prevalent modifiable risk factor, present in about 75% of patients, while other risk factors include atherosclerosis, connective tissue disorders, and previous cardiac surgery.

• #16 Aortic Dissection: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2062452-overview

  In the United States, aortic dissection is an uncommon disease. The true frequency of aortic dissection is difficult to estimate, and most estimates are based on autopsy studies. Evidence of aortic dissection is found in 1-3% of all autopsies (1 in 350 cadavers). The incidence of aortic dissection is estimated to be 5-30 cases per 1 million people per year. Aortic dissection occurs once per 10,000 patients admitted to the hospital; approximately 2000 new cases are reported each year in the United States. […] Aortic dissection is more common in blacks than in whites and is less common in Asians than in whites. Also, it is more common in males than females, with a male-to-female ratio of 2-3:1. […] Approximately 75% of dissections occur in those aged 40-70 years, with a peak in the range of 50-65 years. Patients with Marfan syndrome present earlier, usually in the third and fourth decades of life.

• #17 Aortic dissection – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_dissection

  Aortic dissection affects an estimated 2.0-3.5 people per every 100,000 every year. […] Studies from Sweden suggest that the incidence of aortic dissection may be rising. […] Men are more commonly affected than women: 65% of all people with aortic dissection are male. […] The mean age at diagnosis is 63 years. […] In females before the age of 40, half of all aortic dissections occur during pregnancy (typically in the third trimester or early postpartum period). […] Dissection occurs in about 0.6% of pregnancies.

• #18

  https://journals.lww.com/cardioplus/fulltext/2022/12000/aortic_dissection__global_epidemiology.1.aspx

  The significant differences observed in serum markers require further discussion and were generally more common in older patients compared with younger patients. […] The incidence of male aortic dissection patients was nearly 61.5% in Australia, 56.0% to 65.0% in Canada and the United States, 67.1% in the IRAD study, and 67.6% in North Europe. […] The incidence of aortic dissection has risen sharply in the older adult population and is reported to be 8.6/100,000 in ages 60 to 80 years and 32/100,000 for people aged over 80 years. […] Studies have reported that operated type A aortic dissection cases in Japan are 27.2 per million persons annually, more than four times higher than in Western countries including the United States and European countries. […] The incidence of aortic dissection during pregnancy was approximately 1.45/100,000 and the condition appeared in approximately 20% of maternal cardiac deaths. […] Although the incidence of aortic dissection remains relatively stable globally, transportation and key population screening still need considerable improvement, especially in developing countries.

• #19 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  Acute aortic dissection is a rare but life-threatening condition, with an incidence of 5 to 30 cases per 1 million people per year. This contrasts sharply with acute myocardial infarction, which has approximately 4400 cases per 1 million people annually. Aortic dissection accounts for 3 out of every 1000 emergency department presentations involving acute chest, back, or abdominal pain. The condition predominantly affects individuals between 40 and 70, with most cases occurring in patients aged 50 to 65. Approximately 75% of dissections happen in this age range, highlighting age as a key risk factor. […] While men are 3 times more likely to develop aortic dissection than women, women often present later in the disease course and have worse outcomes. The risk profile differs between older and younger patients: older patients are more likely to have hypertension, atherosclerosis, prior aortic aneurysm, or iatrogenic dissection, while younger patients, particularly those younger than 40, are more likely to have connective tissue disorders like Marfan syndrome. Type A dissections involving the ascending aorta are twice as common as type B dissections and are more likely to be fatal without urgent intervention. Hypertension is the most prevalent modifiable risk factor, present in about 75% of patients, while other risk factors include atherosclerosis, connective tissue disorders, and previous cardiac surgery.

• #20 Aortic dissection – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_dissection

  Aortic dissection affects an estimated 2.0-3.5 people per every 100,000 every year. […] Studies from Sweden suggest that the incidence of aortic dissection may be rising. […] Men are more commonly affected than women: 65% of all people with aortic dissection are male. […] The mean age at diagnosis is 63 years. […] In females before the age of 40, half of all aortic dissections occur during pregnancy (typically in the third trimester or early postpartum period). […] Dissection occurs in about 0.6% of pregnancies.

• #21 A Contemporary Review of Acute Aortic Dissection

  https://www.longdom.org/open-access/a-contemporary-review-of-acute-aortic-dissection-43401.html

  Acute aortic dissection is one of the most rapidly fatal clinical entities that can be encountered in the emergency department setting. […] The aim of this paper is to perform an up-to-date clinical review of acute aortic dissection including its epidemiology, risk factors, clinical presentation, algorithms in establishing the diagnosis, and of available medical and surgical therapies. […] In the United States and Western Europe, the incidence of AD has been approximated to range between 2.9 and 3.5 cases per 100,000 person-years. […] In the Swedish population, where autopsies are routinely required on all unexpected out-of-hospital deaths, there was a reported 52% increase in the incidence of thoracic aortic aneurysm and dissection in Swedish men between 1987 and 2002. […] In England and Wales, admission for thoracic AD increased from ~ 10 to ~ 12 per 100,000 in individuals 75 years old from 1999-2001 to 2008-2010. […] Improvements in emergency medical services may contribute to the reported rise in incidence of AD. […] An IRAD review of 1078 patients with AD found that ~ 32% of patients were women and that women with AD were older than men.

• #22 Epidemiology of thoracic aortic dissection | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2010.187

  Other risk factors for TAD include inflammatory diseases, iatrogenic aortic injury, and drug use. […] Congenital cardiovascular defects, such as bicuspid aortic valve, and certain genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with TAD. […] The incidence of thoracic aortic dissection is probably underestimated (34 cases per 100,000 persons per year) and seems to be increasing, in part because of improvements in diagnostic imaging. […] Thoracic aortic dissection is a major cause of mortality in the general population, with rupture being the most common cause of death. […] Male sex and older age are risk factors for thoracic aortic dissection. […] Although atherosclerosis and typical cardiovascular risk factors are associated with thoracic aortic dissection, evidence supporting their direct causal role is lacking, and diabetes is remarkably uncommon in these patients. […] Congenital cardiovascular defects, such as bicuspid aortic valve, and genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with thoracic aortic dissection.

• #23 Incidence, risk factors, outcome and projected future burden of acute aortic dissection – Howard- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/3876/html

  Acute aortic dissection has a high mortality rate, despite well-established treatment guidelines. Data on risk factors, incidence and outcome of aortic dissection are limited, largely due to a lack of contemporary population-based studies of this condition. This research highlight outlines the findings of our recent population-based research of acute aortic dissection, which is the first-ever prospective epidemiological study of this condition. We studied event rates, incidence, risk factors, early case fatality, and long-term outcome of all acute aortic events occurring in a population of 92,728 in Oxfordshire, UK, during 2002-2012, as part of the Oxford Vascular Study (OXVASC). Current event rates for the whole UK population were projected based on measured OXVASC incidence rates and the 2010 UK census population. Future event rates for the UK population were projected based on current OXVASC incidence rates and the ONS national population projections by age and sex for the UK for 2030 and 2050. Based on current incidence rates and projected evolution of age/sex population structure, annual incident events in the UK will increase from 3,892 in 2010 to as many as 6,893 in 2050. Our data suggest that over 50% of incident dissection events will occur at age 75 years by 2050 and that the total number of incident events each year may almost double if pre-morbid risk factors are not better controlled.

• #24 Risk Factors for Aortic Dissection | USC Journal

  https://www.uscjournal.com/articles/risk-factors-aortic-dissection?language_content_entity=en

  Aortic dissection is a critical condition, which can affect the aorta over its entire length. Characterized by a split between the tunica intima and the tunica media of the aorta, aortic dissection is seen in both sexes, and diagnosis and treatment are decisive for the survival of the patient. Aortic dissection has a wide range of risk factors that contribute to it being one of the most serious of cardiovascular conditions. Diagnosis is based on a thorough knowledge of the condition and its risk factors. This review describes the patient characteristics, drugs, and medical procedures that may contribute to an increased risk of aortic dissection, raising awareness of this life-threatening condition. […] Understanding the risk factors for AD is important for disease management. The aim of this review is to describe the patient characteristics, drugs, and medical procedures that may contribute to an increased risk of AD, raising awareness of this life-threatening condition.

• #25 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  Acute aortic dissection is a rare but life-threatening condition, with an incidence of 5 to 30 cases per 1 million people per year. This contrasts sharply with acute myocardial infarction, which has approximately 4400 cases per 1 million people annually. Aortic dissection accounts for 3 out of every 1000 emergency department presentations involving acute chest, back, or abdominal pain. The condition predominantly affects individuals between 40 and 70, with most cases occurring in patients aged 50 to 65. Approximately 75% of dissections happen in this age range, highlighting age as a key risk factor. […] While men are 3 times more likely to develop aortic dissection than women, women often present later in the disease course and have worse outcomes. The risk profile differs between older and younger patients: older patients are more likely to have hypertension, atherosclerosis, prior aortic aneurysm, or iatrogenic dissection, while younger patients, particularly those younger than 40, are more likely to have connective tissue disorders like Marfan syndrome. Type A dissections involving the ascending aorta are twice as common as type B dissections and are more likely to be fatal without urgent intervention. Hypertension is the most prevalent modifiable risk factor, present in about 75% of patients, while other risk factors include atherosclerosis, connective tissue disorders, and previous cardiac surgery.

• #26 Acute aortic dissection: pathogenesis, risk factors and diagnosis

  https://smw.ch/index.php/smw/article/download/2356/3595?inline=1

  Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. […] The incidence of acute aortic syndromes in the general population ranges from 4 to 6 cases per 100000 person-years, but increases up to 30 or more in people older than 65 years. […] Hypertension is considered as the most important risk factor for aortic dissection and is present in about 80% of patients with aortic dissection. In the general population, hypertension contributes 54% of population-attributable risk of acute aortic dissection, and with an incidence rate of 21 per 100000 person-years compared with 5 in normotensive individuals. […] With an age-adjusted incidence of five versus two per 100000 person-years, men are at higher risk of developing aortic dissection than women.

• #27 Acute aortic dissection: pathogenesis, risk factors and diagnosis

  https://smw.ch/index.php/smw/article/download/2356/3595?inline=1

  Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. […] The incidence of acute aortic syndromes in the general population ranges from 4 to 6 cases per 100000 person-years, but increases up to 30 or more in people older than 65 years. […] Hypertension is considered as the most important risk factor for aortic dissection and is present in about 80% of patients with aortic dissection. In the general population, hypertension contributes 54% of population-attributable risk of acute aortic dissection, and with an incidence rate of 21 per 100000 person-years compared with 5 in normotensive individuals. […] With an age-adjusted incidence of five versus two per 100000 person-years, men are at higher risk of developing aortic dissection than women.

• #28 Aortic dissection – EMCrit Project

  https://emcrit.org/ibcc/aortic-dissection/

  Older age (typically ~50s-70s). […] Type A dissection is more common in the ~50s-60s. […] Type B dissection is more common in the ~60s-70s. […] Male predominance. […] History of hypertension (70%). […] Marfan syndrome carries a 5% risk of aortic dissection. […] Among aortic dissection patients 40 years old, about half have Marfan syndrome. […] Without therapy, 70% of patients will die within the first two weeks. […] If a patient presents who has already survived for 2 weeks without therapy, this reduces the likelihood that they will deteriorate. […] Serial CT angiography may be helpful in surveilling disease progression that could require intervention.

• #29

  https://smw.ch/index.php/smw/article/view/2356

  Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. […] Advanced age, male gender, long-term history of arterial hypertension and the presence of aortic aneurysm confer the greatest population attributable risk. […] However, patients with genetic connective tissue disorders such as Marfan, Loeys Dietz or Ehlers Danlos syndrome, and patients with bicuspid aortic valves are at the increased risk of aortic dissection at a much younger age. […] Imaging provides a robust foundation for diagnosing acute aortic dissection, as well as for monitoring of patients at increased risk of aortic disease. […] As yet, easily accessible blood tests play only a small role but have the potential to make diagnosis and monitoring of patients simpler and more cost-effective. […] Mszros I, Mrocz J, Szlvi J, Schmidt J, Tornci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117(5):12718. doi:.https://doi.org/10.1378/chest.117.5.1271

• #30

  https://smw.ch/index.php/smw/article/view/2356

  Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. […] Advanced age, male gender, long-term history of arterial hypertension and the presence of aortic aneurysm confer the greatest population attributable risk. […] However, patients with genetic connective tissue disorders such as Marfan, Loeys Dietz or Ehlers Danlos syndrome, and patients with bicuspid aortic valves are at the increased risk of aortic dissection at a much younger age. […] Imaging provides a robust foundation for diagnosing acute aortic dissection, as well as for monitoring of patients at increased risk of aortic disease. […] As yet, easily accessible blood tests play only a small role but have the potential to make diagnosis and monitoring of patients simpler and more cost-effective. […] Mszros I, Mrocz J, Szlvi J, Schmidt J, Tornci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117(5):12718. doi:.https://doi.org/10.1378/chest.117.5.1271

• #31 Aortic dissection | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/aortic-dissection?lang=us

  The majority of aortic dissections are seen in elderly hypertensive patients. In a very small minority, an underlying connective tissue disorder may be present. Other conditions or predisposing factors may also be encountered, in which case they will be reflected in the demographics. Examples include atherosclerosis, structural aortic abnormalities, and Turner syndrome, which is an under-recognized, common cause of dissection in young women. Interestingly, there is a reported seasonal pattern of disease, with great risk in winter and during morning hours.

• #32 Aortic dissection – EMCrit Project

  https://emcrit.org/ibcc/aortic-dissection/

  Older age (typically ~50s-70s). […] Type A dissection is more common in the ~50s-60s. […] Type B dissection is more common in the ~60s-70s. […] Male predominance. […] History of hypertension (70%). […] Marfan syndrome carries a 5% risk of aortic dissection. […] Among aortic dissection patients 40 years old, about half have Marfan syndrome. […] Without therapy, 70% of patients will die within the first two weeks. […] If a patient presents who has already survived for 2 weeks without therapy, this reduces the likelihood that they will deteriorate. […] Serial CT angiography may be helpful in surveilling disease progression that could require intervention.

• #33 Epidemiology of thoracic aortic dissection | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2010.187

  Other risk factors for TAD include inflammatory diseases, iatrogenic aortic injury, and drug use. […] Congenital cardiovascular defects, such as bicuspid aortic valve, and certain genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with TAD. […] The incidence of thoracic aortic dissection is probably underestimated (34 cases per 100,000 persons per year) and seems to be increasing, in part because of improvements in diagnostic imaging. […] Thoracic aortic dissection is a major cause of mortality in the general population, with rupture being the most common cause of death. […] Male sex and older age are risk factors for thoracic aortic dissection. […] Although atherosclerosis and typical cardiovascular risk factors are associated with thoracic aortic dissection, evidence supporting their direct causal role is lacking, and diabetes is remarkably uncommon in these patients. […] Congenital cardiovascular defects, such as bicuspid aortic valve, and genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with thoracic aortic dissection.

• #34

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-cardiovascular/thoracic-aortic-dissection

  The incidence of thoracic aortic dissection is approximately three per 100,000 person-years. […] Because of the high mortality and elusive nature of this disease, this is likely a gross underestimation. […] Thoracic aortic dissection is at least twice as common in males as females, and the prevalence of this condition increases with age. […] Risk factors are numerous and include genetic syndromes and both acute and chronic cardiovascular conditions. […] Genetic syndromes that place patients at increased risk of thoracic aortic dissection include Marfan syndrome, Loeys-Dietz syndrome, Turner syndrome, and Ehlers-Danlos syndrome (vascular type). […] Patients with a family history of aortic dissection or aneurysm, or with a personal history of aortic aneurysm or coarctation, chronic hypertension, acute hypertension (as in stimulant abuse), polycystic kidney disease, inflammatory vasculitis (e.g., giant cell arteritis), or pre-existing aortic valvular disease (e.g., bicuspid aortic valve), are also at increased risk.

• #35 Epidemiology of thoracic aortic dissection | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2010.187

  Thoracic aortic dissection (TAD) is estimated to occur at a rate of 34 cases per 100,000 persons per year and is associated with a high mortality. […] Reported rates are probably underestimates of the true incidence of TAD because of difficulties in diagnosis. […] The incidence of TAD appears to have been increasing over time. […] TAD is most common in men and older individuals. […] Aortic dilatation is a well-established risk factor for TAD but is not a prerequisite; most ascending aortic dissections occur when aortic diameter is 5.5 cm. […] Although atherosclerosis and typical cardiovascular risk factors, such as hypertension and smoking, are associated with TAD, evidence supporting their direct causal role is lacking. […] Notably, diabetes mellitus is remarkably uncommon in patients with TAD.

• #36 Acute aortic dissection: pathogenesis, risk factors and diagnosis

  https://smw.ch/index.php/smw/article/download/2356/3595?inline=1

  The mean age at the onset of aortic dissection is approximately 65 years. […] The annual rate of acute aortic dissection progressively increases as the aortic diameter increases, and the incidence of aortic complications reaches 30% once the aortic diameter reaches 60 mm. […] Aortitis, complications caused by giant cell arteritis, Takayasu arteritis or systemic lupus erythematous, are rarer risk factors for aortic dissection, but 1 to 5% of patients with aortitis develop aortic dissection. […] The role of atherosclerosis in the development of aortic dissection remains unclear. […] Patients with known aortic aneurysm, genetic connective tissue disorders or a bicuspid aortic valve should undergo serial assessment of the aorta until it reaches a critical diameter at which the risk of dissection or rupture significantly increases.

• #37 Epidemiology of thoracic aortic dissection | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2010.187

  Thoracic aortic dissection (TAD) is estimated to occur at a rate of 34 cases per 100,000 persons per year and is associated with a high mortality. […] Reported rates are probably underestimates of the true incidence of TAD because of difficulties in diagnosis. […] The incidence of TAD appears to have been increasing over time. […] TAD is most common in men and older individuals. […] Aortic dilatation is a well-established risk factor for TAD but is not a prerequisite; most ascending aortic dissections occur when aortic diameter is 5.5 cm. […] Although atherosclerosis and typical cardiovascular risk factors, such as hypertension and smoking, are associated with TAD, evidence supporting their direct causal role is lacking. […] Notably, diabetes mellitus is remarkably uncommon in patients with TAD.

• #38

  https://journals.lww.com/cardioplus/fulltext/2022/12000/aortic_dissection__global_epidemiology.1.aspx

  The significant differences observed in serum markers require further discussion and were generally more common in older patients compared with younger patients. […] The incidence of male aortic dissection patients was nearly 61.5% in Australia, 56.0% to 65.0% in Canada and the United States, 67.1% in the IRAD study, and 67.6% in North Europe. […] The incidence of aortic dissection has risen sharply in the older adult population and is reported to be 8.6/100,000 in ages 60 to 80 years and 32/100,000 for people aged over 80 years. […] Studies have reported that operated type A aortic dissection cases in Japan are 27.2 per million persons annually, more than four times higher than in Western countries including the United States and European countries. […] The incidence of aortic dissection during pregnancy was approximately 1.45/100,000 and the condition appeared in approximately 20% of maternal cardiac deaths. […] Although the incidence of aortic dissection remains relatively stable globally, transportation and key population screening still need considerable improvement, especially in developing countries.

• #39 Aortic dissection – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_dissection

  Aortic dissection affects an estimated 2.0-3.5 people per every 100,000 every year. […] Studies from Sweden suggest that the incidence of aortic dissection may be rising. […] Men are more commonly affected than women: 65% of all people with aortic dissection are male. […] The mean age at diagnosis is 63 years. […] In females before the age of 40, half of all aortic dissections occur during pregnancy (typically in the third trimester or early postpartum period). […] Dissection occurs in about 0.6% of pregnancies.

• #40 Acute aortic dissection: pathogenesis, risk factors and diagnosis

  https://smw.ch/index.php/smw/article/download/2356/3595?inline=1

  The mean age at the onset of aortic dissection is approximately 65 years. […] The annual rate of acute aortic dissection progressively increases as the aortic diameter increases, and the incidence of aortic complications reaches 30% once the aortic diameter reaches 60 mm. […] Aortitis, complications caused by giant cell arteritis, Takayasu arteritis or systemic lupus erythematous, are rarer risk factors for aortic dissection, but 1 to 5% of patients with aortitis develop aortic dissection. […] The role of atherosclerosis in the development of aortic dissection remains unclear. […] Patients with known aortic aneurysm, genetic connective tissue disorders or a bicuspid aortic valve should undergo serial assessment of the aorta until it reaches a critical diameter at which the risk of dissection or rupture significantly increases.

• #41 Epidemiology of thoracic aortic dissection | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2010.187

  Other risk factors for TAD include inflammatory diseases, iatrogenic aortic injury, and drug use. […] Congenital cardiovascular defects, such as bicuspid aortic valve, and certain genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with TAD. […] The incidence of thoracic aortic dissection is probably underestimated (34 cases per 100,000 persons per year) and seems to be increasing, in part because of improvements in diagnostic imaging. […] Thoracic aortic dissection is a major cause of mortality in the general population, with rupture being the most common cause of death. […] Male sex and older age are risk factors for thoracic aortic dissection. […] Although atherosclerosis and typical cardiovascular risk factors are associated with thoracic aortic dissection, evidence supporting their direct causal role is lacking, and diabetes is remarkably uncommon in these patients. […] Congenital cardiovascular defects, such as bicuspid aortic valve, and genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with thoracic aortic dissection.

• #42

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-cardiovascular/thoracic-aortic-dissection

  The incidence of thoracic aortic dissection is approximately three per 100,000 person-years. […] Because of the high mortality and elusive nature of this disease, this is likely a gross underestimation. […] Thoracic aortic dissection is at least twice as common in males as females, and the prevalence of this condition increases with age. […] Risk factors are numerous and include genetic syndromes and both acute and chronic cardiovascular conditions. […] Genetic syndromes that place patients at increased risk of thoracic aortic dissection include Marfan syndrome, Loeys-Dietz syndrome, Turner syndrome, and Ehlers-Danlos syndrome (vascular type). […] Patients with a family history of aortic dissection or aneurysm, or with a personal history of aortic aneurysm or coarctation, chronic hypertension, acute hypertension (as in stimulant abuse), polycystic kidney disease, inflammatory vasculitis (e.g., giant cell arteritis), or pre-existing aortic valvular disease (e.g., bicuspid aortic valve), are also at increased risk.

• #43 Epidemiology of thoracic aortic dissection | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2010.187

  Thoracic aortic dissection (TAD) is estimated to occur at a rate of 34 cases per 100,000 persons per year and is associated with a high mortality. […] Reported rates are probably underestimates of the true incidence of TAD because of difficulties in diagnosis. […] The incidence of TAD appears to have been increasing over time. […] TAD is most common in men and older individuals. […] Aortic dilatation is a well-established risk factor for TAD but is not a prerequisite; most ascending aortic dissections occur when aortic diameter is 5.5 cm. […] Although atherosclerosis and typical cardiovascular risk factors, such as hypertension and smoking, are associated with TAD, evidence supporting their direct causal role is lacking. […] Notably, diabetes mellitus is remarkably uncommon in patients with TAD.

• #44 Epidemiology of thoracic aortic dissection | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2010.187

  Other risk factors for TAD include inflammatory diseases, iatrogenic aortic injury, and drug use. […] Congenital cardiovascular defects, such as bicuspid aortic valve, and certain genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with TAD. […] The incidence of thoracic aortic dissection is probably underestimated (34 cases per 100,000 persons per year) and seems to be increasing, in part because of improvements in diagnostic imaging. […] Thoracic aortic dissection is a major cause of mortality in the general population, with rupture being the most common cause of death. […] Male sex and older age are risk factors for thoracic aortic dissection. […] Although atherosclerosis and typical cardiovascular risk factors are associated with thoracic aortic dissection, evidence supporting their direct causal role is lacking, and diabetes is remarkably uncommon in these patients. […] Congenital cardiovascular defects, such as bicuspid aortic valve, and genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with thoracic aortic dissection.

• #45 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  Patients who are Black, male, or older, and patients with hypertension are especially at risk for aortic dissection (1, 2). Peak incidence occurs at age 50 to 65 years in the general population and at age 20 to 40 years for patients with congenital connective tissue disorders (eg, Marfan syndrome, Ehlers-Danlos syndrome). […] Atherosclerotic risk factors, notably hypertension, contribute in more than two-thirds of patients. […] About 20% of patients with aortic dissection die before reaching the hospital. Without treatment, mortality rate is approximately 1 to 2% per hour after symptom onset. Without surgery, mortality is 50% at 1 month (1). Hospital mortality rate for treated patients is about 20% for type A dissection and 10% for type B dissection (2). One of the largest international registry databases reported survival rates of 90 percent for type A dissections treated surgically at 1 and 3 years postdischarge. However, the 3-year survival rate of patients with type B dissection was 78% for those treated with medical management alone. […] After repair of a dissection, the aorta should be monitored for the rest of the patient’s life. The weakened aorta may develop aneurysmal degeneration above or below the surgical repair or re-dissect. For these reasons, continued surveillance is indicated.

• #46

  https://journals.lww.com/cardioplus/fulltext/2022/12000/aortic_dissection__global_epidemiology.1.aspx

  Aortic dissection is a highly fatal disease with limited predictability requiring emergency response. It remains a challenging clinical problem and has a reported lower 5-year survival rate, especially in acute cases. Studying the epidemiology of aortic dissection can be important for targeting key populations and developing public health policies. […] The reported prevalence of aortic dissection after autopsy is as much as 1% to 3% and the annual incidence rate of type A aortic dissection is roughly 3/100,000. […] The mortality rate is approximately 1% per hour initially and 50% by the third day for untreated aortic dissection. […] A 20-year national study showed a significant decrease in in-hospital mortality for type A but not for such a trend was not seen for type B. […] In the past, the research and application of the epidemiology of aortic dissection have focused on in-hospital and follow-up mortality. Incidence data have rarely been generated or provided.

• #47

  https://smw.ch/index.php/smw/article/view/2356

  Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. […] Advanced age, male gender, long-term history of arterial hypertension and the presence of aortic aneurysm confer the greatest population attributable risk. […] However, patients with genetic connective tissue disorders such as Marfan, Loeys Dietz or Ehlers Danlos syndrome, and patients with bicuspid aortic valves are at the increased risk of aortic dissection at a much younger age. […] Imaging provides a robust foundation for diagnosing acute aortic dissection, as well as for monitoring of patients at increased risk of aortic disease. […] As yet, easily accessible blood tests play only a small role but have the potential to make diagnosis and monitoring of patients simpler and more cost-effective. […] Mszros I, Mrocz J, Szlvi J, Schmidt J, Tornci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117(5):12718. doi:.https://doi.org/10.1378/chest.117.5.1271

• #48 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  Patients who are Black, male, or older, and patients with hypertension are especially at risk for aortic dissection (1, 2). Peak incidence occurs at age 50 to 65 years in the general population and at age 20 to 40 years for patients with congenital connective tissue disorders (eg, Marfan syndrome, Ehlers-Danlos syndrome). […] Atherosclerotic risk factors, notably hypertension, contribute in more than two-thirds of patients. […] About 20% of patients with aortic dissection die before reaching the hospital. Without treatment, mortality rate is approximately 1 to 2% per hour after symptom onset. Without surgery, mortality is 50% at 1 month (1). Hospital mortality rate for treated patients is about 20% for type A dissection and 10% for type B dissection (2). One of the largest international registry databases reported survival rates of 90 percent for type A dissections treated surgically at 1 and 3 years postdischarge. However, the 3-year survival rate of patients with type B dissection was 78% for those treated with medical management alone. […] After repair of a dissection, the aorta should be monitored for the rest of the patient’s life. The weakened aorta may develop aneurysmal degeneration above or below the surgical repair or re-dissect. For these reasons, continued surveillance is indicated.

• #49 Acute aortic dissection

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-12/Acute-aortic-dissection

  A high index of suspicion is required for prompt diagnosis and treatment of deadly and relatively rare aortic dissection yet diagnosis is both elusive and challenging, with a diversity of manifestations, depending on where it occurs along the aorta. […] The annual incidence of aortic dissection – 5 to 30 per million is low compared to that of myocardial infarction which is 4,000 per million. […] Cardiovascular morbidity and mortality associated with this condition are high. Hospital-based mortality rates are approximately 30%. Patients with type A aortic dissection who undergo surgical treatment have a 30% mortality rate; patients who receive medical treatment have a mortality rate of 60%. […] Systemic hypertension is the most important predisposing factor for acute aortic dissection – it has been reported in 70% of the patients with aortic dissection.

• #50 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  Patients who are Black, male, or older, and patients with hypertension are especially at risk for aortic dissection (1, 2). Peak incidence occurs at age 50 to 65 years in the general population and at age 20 to 40 years for patients with congenital connective tissue disorders (eg, Marfan syndrome, Ehlers-Danlos syndrome). […] Atherosclerotic risk factors, notably hypertension, contribute in more than two-thirds of patients. […] About 20% of patients with aortic dissection die before reaching the hospital. Without treatment, mortality rate is approximately 1 to 2% per hour after symptom onset. Without surgery, mortality is 50% at 1 month (1). Hospital mortality rate for treated patients is about 20% for type A dissection and 10% for type B dissection (2). One of the largest international registry databases reported survival rates of 90 percent for type A dissections treated surgically at 1 and 3 years postdischarge. However, the 3-year survival rate of patients with type B dissection was 78% for those treated with medical management alone. […] After repair of a dissection, the aorta should be monitored for the rest of the patient’s life. The weakened aorta may develop aneurysmal degeneration above or below the surgical repair or re-dissect. For these reasons, continued surveillance is indicated.

• #51 Acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection – Patel- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/4185/5084

  With the large-scale IRAD study, comparisons regarding the demographics and clinical presentations of patients with type A versus type B disease also became possible. Patients with type B dissection are older, have higher rates of atherosclerosis, and are more likely to present with back pain rather than anterior chest pain. Importantly, half of type B dissections have an initial abnormal chest radiograph. Furthermore, the in-hospital mortality rate is 13% with the majority of deaths occurring within the first week of hospitalization. Independent predictors of death in type B dissection have been jointly termed the deadly triad: hypotension/shock, absence of chest/back pain on presentation, and branch vessel involvement. […] Surveillance imaging for any type B aortic dissection is thought by many to provide benefit regardless of temporal or risk stratification or even treatment applied. In fact, the current 2010 American Heart Association (AHA)/American College Of Cardiology (ACC) guidelines for thoracic aortic disease call for CT or MR imaging of the thoracic aorta at discharge, 1 month, 3, 6, and 12 months postdissection with annual imaging thereafter, if stable. Unfortunately, contemporary epidemiological studies have shown that approximately 52% of patients are lost to follow-up by 28 months postdissection; such noncompliance with the guidelines is concerning as 38% of medically treated type B aortic dissection patients were found to have become complicated and required intervention during the follow-up period. Whether acute, subacute, or chronic, surveillance imaging should remain a cornerstone of optimal therapy.

• #52 Research finds poor level of surveillance following aortic dissection repair – Vascular News

  https://vascularnews.com/research-finds-poor-level-of-surveillance-following-aortic-dissection-repair/

  Patients who survive an aortic dissection often fail to receive comprehensive post-surgical follow-up care leaving them vulnerable to a lifetime of sustained risk. This is according to research published in the Journal of the American College of Cardiology (JACC), authored by Jennifer Chung (Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada) and colleagues, looking at surveillance imaging following acute type A aortic dissection. […] What we found in our study was that almost no one was receiving guideline-recommended imaging surveillance (GRIS) after dissection, says Chung. […] Chung’s study examined 888 Ontarians who survived urgent aortic dissection repair between 1 April 2005 and 31 March 2018. If one survived the surgery, the mortality rate was 4% after one year, 14% at five years, and 29% at 10 years. The study also showed that the rate of surveillance imaging dropped to 21% just two years post-surgery, and at eight years, it was less than 2%.

• #53 Imaging and Surveillance of Chronic Aortic Dissection – Professional Heart Daily | American Heart Association

  https://professional.heart.org/en/science-news/imaging-and-surveillance-of-chronic-aortic-dissection

  This scientific statement considers measurement techniques for patients with chronic aortic dissection, including the need for standardized measurements in life-long surveillance. […] Patients surviving an acute aortic dissection require continued life-long surveillance of their diseased aorta. […] Imaging plays a central role in the surveillance of patients with chronic aortic dissection.

• #54 Aortic dissection – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000226

  Lifelong surveillance is needed with regular imaging to detect complications which may later require surgery. […] Fleischmann D, Afifi RO, Casanegra AI, et al. Imaging and surveillance of chronic aortic dissection: a scientific statement from the American Heart Association. Circ Cardiovasc Imaging. 2022 Mar;15(3):e000075.

• #55 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  Patients who are Black, male, or older, and patients with hypertension are especially at risk for aortic dissection (1, 2). Peak incidence occurs at age 50 to 65 years in the general population and at age 20 to 40 years for patients with congenital connective tissue disorders (eg, Marfan syndrome, Ehlers-Danlos syndrome). […] Atherosclerotic risk factors, notably hypertension, contribute in more than two-thirds of patients. […] About 20% of patients with aortic dissection die before reaching the hospital. Without treatment, mortality rate is approximately 1 to 2% per hour after symptom onset. Without surgery, mortality is 50% at 1 month (1). Hospital mortality rate for treated patients is about 20% for type A dissection and 10% for type B dissection (2). One of the largest international registry databases reported survival rates of 90 percent for type A dissections treated surgically at 1 and 3 years postdischarge. However, the 3-year survival rate of patients with type B dissection was 78% for those treated with medical management alone. […] After repair of a dissection, the aorta should be monitored for the rest of the patient’s life. The weakened aorta may develop aneurysmal degeneration above or below the surgical repair or re-dissect. For these reasons, continued surveillance is indicated.

• #56 Acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection – Patel- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/4185/5084

  With the large-scale IRAD study, comparisons regarding the demographics and clinical presentations of patients with type A versus type B disease also became possible. Patients with type B dissection are older, have higher rates of atherosclerosis, and are more likely to present with back pain rather than anterior chest pain. Importantly, half of type B dissections have an initial abnormal chest radiograph. Furthermore, the in-hospital mortality rate is 13% with the majority of deaths occurring within the first week of hospitalization. Independent predictors of death in type B dissection have been jointly termed the deadly triad: hypotension/shock, absence of chest/back pain on presentation, and branch vessel involvement. […] Surveillance imaging for any type B aortic dissection is thought by many to provide benefit regardless of temporal or risk stratification or even treatment applied. In fact, the current 2010 American Heart Association (AHA)/American College Of Cardiology (ACC) guidelines for thoracic aortic disease call for CT or MR imaging of the thoracic aorta at discharge, 1 month, 3, 6, and 12 months postdissection with annual imaging thereafter, if stable. Unfortunately, contemporary epidemiological studies have shown that approximately 52% of patients are lost to follow-up by 28 months postdissection; such noncompliance with the guidelines is concerning as 38% of medically treated type B aortic dissection patients were found to have become complicated and required intervention during the follow-up period. Whether acute, subacute, or chronic, surveillance imaging should remain a cornerstone of optimal therapy.

• #57 AHA: Imaging and Surveillance of Chronic Aortic Dissection, a Scientific Statement – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/home/topics/vascular-medicine/american-heart-association-aha-imaging-surveillance-chronic-aortic-dissection/

  Computed tomography angiography (CTA) is the most common imaging surveillance tool for chronic aortic dissection. […] Acceptable alternative imaging approaches include magnetic resonance imaging (MRI), transthoracic echocardiography (TTE), and transesophageal echocardiogram (TEE). […] Risk for aortic rupture is evaluated by measuring aortic caliber and adjacent segments. […] In order to provide the best surveillance care, serial measurements should always be obtained in the same anatomic location and identical orientation along the aorta with direct side-by-side comparisons. […] Chronic aortic dissection is an underrecognized cardiovascular disease and growing health care burden, the statement authors wrote. Imaging and image processing will continue to play a pivotal role in surveillance and clinical decision-making in these patients, as long as accurate and standardized measurements of aortic dimensions over time are provided.

• #58 Acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection – Patel- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/4185/5084

  With the large-scale IRAD study, comparisons regarding the demographics and clinical presentations of patients with type A versus type B disease also became possible. Patients with type B dissection are older, have higher rates of atherosclerosis, and are more likely to present with back pain rather than anterior chest pain. Importantly, half of type B dissections have an initial abnormal chest radiograph. Furthermore, the in-hospital mortality rate is 13% with the majority of deaths occurring within the first week of hospitalization. Independent predictors of death in type B dissection have been jointly termed the deadly triad: hypotension/shock, absence of chest/back pain on presentation, and branch vessel involvement. […] Surveillance imaging for any type B aortic dissection is thought by many to provide benefit regardless of temporal or risk stratification or even treatment applied. In fact, the current 2010 American Heart Association (AHA)/American College Of Cardiology (ACC) guidelines for thoracic aortic disease call for CT or MR imaging of the thoracic aorta at discharge, 1 month, 3, 6, and 12 months postdissection with annual imaging thereafter, if stable. Unfortunately, contemporary epidemiological studies have shown that approximately 52% of patients are lost to follow-up by 28 months postdissection; such noncompliance with the guidelines is concerning as 38% of medically treated type B aortic dissection patients were found to have become complicated and required intervention during the follow-up period. Whether acute, subacute, or chronic, surveillance imaging should remain a cornerstone of optimal therapy.

• #59 Research finds poor level of surveillance following aortic dissection repair – Vascular News

  https://vascularnews.com/research-finds-poor-level-of-surveillance-following-aortic-dissection-repair/

  Patients who survive an aortic dissection often fail to receive comprehensive post-surgical follow-up care leaving them vulnerable to a lifetime of sustained risk. This is according to research published in the Journal of the American College of Cardiology (JACC), authored by Jennifer Chung (Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada) and colleagues, looking at surveillance imaging following acute type A aortic dissection. […] What we found in our study was that almost no one was receiving guideline-recommended imaging surveillance (GRIS) after dissection, says Chung. […] Chung’s study examined 888 Ontarians who survived urgent aortic dissection repair between 1 April 2005 and 31 March 2018. If one survived the surgery, the mortality rate was 4% after one year, 14% at five years, and 29% at 10 years. The study also showed that the rate of surveillance imaging dropped to 21% just two years post-surgery, and at eight years, it was less than 2%.

• #60 Research finds poor level of surveillance following aortic dissection repair – Vascular News

  https://vascularnews.com/research-finds-poor-level-of-surveillance-following-aortic-dissection-repair/

  Guidelines recommend imaging surveillance at one, six and 12 months, and then annually, following aortic dissection repair. Overall, only 14% of patients underwent surveillance at these timepoints. […] Other factors contributing to the lack of consistent follow-up care include distance between the patient’s residence and the referral centre where they received surgery, and misconceptions surrounding the durability of the repair. […] Addressing this lack in comprehensive post-surgical follow-up is why Chung has established the Thoracic Aortic Surgery Clinic within the Peter Munk Centre of Excellence in Aortic Disease. […] We follow patients with aortic dissections and aortic aneurysm who may need ongoing imaging surveillance and possibly even surgery down the road. By providing clear and accessible follow-up, we hope to prevent future aortic catastrophe.

• #61 Acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection – Patel- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/4185/5084

  With the large-scale IRAD study, comparisons regarding the demographics and clinical presentations of patients with type A versus type B disease also became possible. Patients with type B dissection are older, have higher rates of atherosclerosis, and are more likely to present with back pain rather than anterior chest pain. Importantly, half of type B dissections have an initial abnormal chest radiograph. Furthermore, the in-hospital mortality rate is 13% with the majority of deaths occurring within the first week of hospitalization. Independent predictors of death in type B dissection have been jointly termed the deadly triad: hypotension/shock, absence of chest/back pain on presentation, and branch vessel involvement. […] Surveillance imaging for any type B aortic dissection is thought by many to provide benefit regardless of temporal or risk stratification or even treatment applied. In fact, the current 2010 American Heart Association (AHA)/American College Of Cardiology (ACC) guidelines for thoracic aortic disease call for CT or MR imaging of the thoracic aorta at discharge, 1 month, 3, 6, and 12 months postdissection with annual imaging thereafter, if stable. Unfortunately, contemporary epidemiological studies have shown that approximately 52% of patients are lost to follow-up by 28 months postdissection; such noncompliance with the guidelines is concerning as 38% of medically treated type B aortic dissection patients were found to have become complicated and required intervention during the follow-up period. Whether acute, subacute, or chronic, surveillance imaging should remain a cornerstone of optimal therapy.

• #62 AHA: Imaging and Surveillance of Chronic Aortic Dissection, a Scientific Statement – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/home/topics/vascular-medicine/american-heart-association-aha-imaging-surveillance-chronic-aortic-dissection/

  Computed tomography angiography (CTA) is the most common imaging surveillance tool for chronic aortic dissection. […] Acceptable alternative imaging approaches include magnetic resonance imaging (MRI), transthoracic echocardiography (TTE), and transesophageal echocardiogram (TEE). […] Risk for aortic rupture is evaluated by measuring aortic caliber and adjacent segments. […] In order to provide the best surveillance care, serial measurements should always be obtained in the same anatomic location and identical orientation along the aorta with direct side-by-side comparisons. […] Chronic aortic dissection is an underrecognized cardiovascular disease and growing health care burden, the statement authors wrote. Imaging and image processing will continue to play a pivotal role in surveillance and clinical decision-making in these patients, as long as accurate and standardized measurements of aortic dimensions over time are provided.

• #63 Thoracic aortic aneurysm: Optimal surveillance and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/9/557

  Patients with TAA should be referred to a cardiologist (and a surgeon, if approaching or exceeding surgical criteria) for optimal decision-making in surveillance and management. […] Accurate and reproducible measurements are critical in surveillance, especially when nearing the threshold for intervention. […] Once the modality is established, timing of surveillance and guideline recommendations depend on aortic dimensions and growth and presence of associated conditions. […] An early follow-up scan (6 months after initial TAA diagnosis) is recommended to assess for growth of the aneurysm in patients who have genetic conditions, and annually thereafter if measurements have been stable or more frequently if there is accelerated growth.

• #64 Research finds poor level of surveillance following aortic dissection repair – Vascular News

  https://vascularnews.com/research-finds-poor-level-of-surveillance-following-aortic-dissection-repair/

  Guidelines recommend imaging surveillance at one, six and 12 months, and then annually, following aortic dissection repair. Overall, only 14% of patients underwent surveillance at these timepoints. […] Other factors contributing to the lack of consistent follow-up care include distance between the patient’s residence and the referral centre where they received surgery, and misconceptions surrounding the durability of the repair. […] Addressing this lack in comprehensive post-surgical follow-up is why Chung has established the Thoracic Aortic Surgery Clinic within the Peter Munk Centre of Excellence in Aortic Disease. […] We follow patients with aortic dissections and aortic aneurysm who may need ongoing imaging surveillance and possibly even surgery down the road. By providing clear and accessible follow-up, we hope to prevent future aortic catastrophe.

• #65 Challenges and Innovations in Postoperative Care for Acute Type A Aortic Dissection: The Role of Structured Surveillance and Virtual Wards

  https://www.imrpress.com/journal/RCM/25/11/10.31083/j.rcm2511389

  Acute Type A aortic dissection (ATAAD) represents a life-threatening medical emergency that requires emergent surgical repair. […] A structured and individualized postoperative surveillance program is essential, not only for improving survival rates but also for identifying risk factors necessitating reintervention and enhancing the quality of life. […] In real-world settings adherence to guideline-directed imaging surveillance (GDIS) is poor, leading to underestimation of reintervention rates. […] A comprehensive aortic service should include GDIS, clinical assessments, cardiovascular risk management, and psychological support. […] Since August 2022, a virtual ward has been implemented in our department to facilitate remote monitoring, ensuring tight blood pressure control and early detection of complications.

• #66 Epidemiology of Acute Aortic Dissection in a General Population of 1.4 Million People in Japan　― Shiga Stroke and Heart Attack Registry ―

  https://www.jstage.jst.go.jp/article/circj/87/9/87_CJ-22-0758/_html/-char/en

  The current analysis of a Japanese population-based registry of AAD in a real-world setting clarified the incidence rates of AAD. Compared with previous reports in Western countries, the incidence rate of AAD was higher in Japan, and a female predominance of AAD was identified in older patients with the A-AAD subtype. Further studies are warranted to clarify the underlying reasons for the epidemiological differences in AAD between Japan and other countries.

• #67 Incidence, risk factors, outcome and projected future burden of acute aortic dissection – Howard- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/3876/html

  Acute aortic dissection has a high mortality rate, despite well-established treatment guidelines. Data on risk factors, incidence and outcome of aortic dissection are limited, largely due to a lack of contemporary population-based studies of this condition. This research highlight outlines the findings of our recent population-based research of acute aortic dissection, which is the first-ever prospective epidemiological study of this condition. We studied event rates, incidence, risk factors, early case fatality, and long-term outcome of all acute aortic events occurring in a population of 92,728 in Oxfordshire, UK, during 2002-2012, as part of the Oxford Vascular Study (OXVASC). Current event rates for the whole UK population were projected based on measured OXVASC incidence rates and the 2010 UK census population. Future event rates for the UK population were projected based on current OXVASC incidence rates and the ONS national population projections by age and sex for the UK for 2030 and 2050. Based on current incidence rates and projected evolution of age/sex population structure, annual incident events in the UK will increase from 3,892 in 2010 to as many as 6,893 in 2050. Our data suggest that over 50% of incident dissection events will occur at age 75 years by 2050 and that the total number of incident events each year may almost double if pre-morbid risk factors are not better controlled.

• #68 Challenges and Innovations in Postoperative Care for Acute Type A Aortic Dissection: The Role of Structured Surveillance and Virtual Wards

  https://www.imrpress.com/journal/RCM/25/11/10.31083/j.rcm2511389/htm

  Effective postoperative management of ATAAD is essential for improving long-term outcomes and patient survival. Structured and individualized surveillance programs, strict blood pressure control, and comprehensive support systems, including psychological support, are key components of this management.

• #69 What does the future hold for aortic dissection patient care?

  https://aorticdissectioncharitabletrust.org/future-of-aortic-care/

  The service and expertise have improved in the past 10 years; the Liverpool and London Aortic Rotas have shown a halving in operative mortality. Aortic MDTs are now common and we have seen the introduction of the first aortic fellowship (first completed by Debbie Harrington). […] More recently, the national coordination and organisation of aortic services promises to make a vast improvement for aortic dissection patients thanks to the NHS Acute Aortic Dissection Toolkit (launched in 2022), further development of the National Vascular Registry for aortic procedures, and the inclusion of patient and family opinions when selecting treatment options. […] The current research objective is to better understand what the genetic variants are, and the complete list of environmental factors that affect them.

• #70 Screening for the vulnerable aorta: targeting high-risk groups in the population

  https://bjcardio.co.uk/2023/09/screening-for-the-vulnerable-aorta-targeting-high-risk-groups-in-the-population/

  Thoracic aortic aneurysms are often asymptomatic until patients present with a life-threatening acute aortic syndrome. The vulnerability of an aorta to an acute aortic syndrome is determined by cross-sectional diameter and underlying aetiological factors, such as genotype or acquired disease. Screening the general population for thoracic aneurysms presents multiple resource issues including the availability of imaging modalities. Targeted screening of high-risk groups provides the only currently pragmatic solution. […] Screening for the vulnerable aorta in the population is key to surveillance and timely intervention to avoid an aortic catastrophe. […] Generalised screening of populations for thoracic aortic aneurysm is currently not feasible due to limitations on availability of imaging services. The only pragmatic solution to screening the population for this disease is a focus on high-risk groups. […] Until we have a comprehensive screening programme it is incumbent on all healthcare professionals to have a low threshold for considering acute aortic pathologies when reviewing patients presenting with chest pain. Early diagnosis is key to a successful outcome.

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