[Acute aortic syndromes: an assessment]

The term "acute aortic syndrome" describes a range of severe, painful, potentially life-threatening abnormalities of the aorta. This review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (AD) and its variants intramural hematoma and penetrating atherosclerotic ulcer. The common denominator of acute aortic syndromes is disruption of the media layer of the aorta, with bleeding within the layers (intramural hematoma), along the aortic media resulting in separation of the layers (AD), or transmurally through the wall in the case of ruptured penetrating atherosclerotic ulcer or trauma. The incidence of AD ranges from 2 to 3.5 cases per 100 000 person-years; hypertension and a variety of genetic disorders with altered connective tissues are the most prevalent risk conditions. Recent advances in imaging techniques have helped in understanding the natural history and dynamics of this condition. Prognosis is clearly related to undelayed diagnosis and appropriate surgical repair in case of proximal involvement of the aorta; the advent of endovascular treatment has opened new perspectives in the management of acute aortic syndromes affecting the descending aorta, since this can modify its natural history and improve prognosis.