A Review of Acute Aortic Syndrome: Pathophysiology, Risk Factors, Diagnosis, and Management

Saad Obaid Alotaibi; &rlm;Rawaf Hussain Alsuwaydaa; &rlm;Bandar Khlef Aldhaoy; &rlm;Mudi Naif Alharbi; &rlm;Huda Fawaz Alanazi; &rlm;Dalal Rahil alshammari; &rlm;Manar Ibrahem Alwehaibi; &rlm;Doaa Ali Alyami; &rlm;Albandary Falah Alharbi; Maryam Khudhayr Alrasheedi; &rlm;Muteb Majed Fahad Albaqami; Mansour Fahad Nasser Alshammari; Ahmed Saleh Madws Alrshidi; Bander mohammad Haia Alrasheidi; Abdullah Sulaiman Abdullah Alsudais; Abdulrahman Ibrahim Abdullah Al Fahad

doi:10.25163/angiotherapy.8110094

Angiogenesis, Inflammation & Therapeutics | Online ISSN 2207-872X

REVIEWS (Open Access)

A Review of Acute Aortic Syndrome: Pathophysiology, Risk Factors, Diagnosis, and Management

Saad Obaid Alotaibi ¹, ‏Rawaf Hussain Alsuwaydaa ¹, ‏Bandar Khlef Aldhaoy ¹, ‏Mudi Naif Alharbi ¹, ‏Huda Fawaz Alanazi ¹, ‏Dalal Rahil alshammari ¹, ‏Manar Ibrahem Alwehaibi ¹, ‏Doaa Ali Alyami ¹, ‏Albandary Falah Alharbi ¹, Maryam Khudhayr Alrasheedi ¹, ‏Muteb Majed Fahad Albaqami ¹, Mansour Fahad Nasser Alshammari ¹, Ahmed Saleh Madws Alrshidi ¹, Bander mohammad Haia Alrasheidi ¹, Abdullah Sulaiman Abdullah Alsudais ¹, Abdulrahman Ibrahim Abdullah Al Fahad ¹*

+ Author Affiliations

Journal of Angiotherapy 8 (1) 1-10 https://doi.org/10.25163/angiotherapy.8110094

Submitted: 01 December 2023 Revised: 14 January 2024 Published: 15 January 2024

Abstract

Background: Acute Aortic Syndrome (AAS) encompasses a group of severe aortic pathologies, including Acute Aortic Dissection (AAD), Intramural Hematoma (IMH), and Penetrating Aortic Ulcer (PAU). These conditions share overlapping clinical presentations but arise from distinct pathological mechanisms and can coexist. The urgency of AAS is underscored by the rapid increase in mortality rates, particularly in type A dissections, with early intervention being crucial for patient survival. This review explores the pathophysiology, clinical features, and management strategies of AAS. Methods: A comprehensive review of the current literature on AAS was conducted, analyzing studies on etiology, risk factors, diagnostic imaging, and treatment outcomes. Emphasis was placed on recent advances in diagnostic techniques such as computed tomography (CT) angiography and the management of AAS subtypes based on clinical guidelines. Results: AAS pathologies originate from different mechanisms: AAD results from an intimal tear and is often complicated by cystic medial necrosis, while IMH occurs due to the rupture of vasa vasorum, and PAU arises from atherosclerotic plaque erosion. Risk factors for AAS include hypertension, smoking, genetic conditions, and trauma. Imaging studies, especially CT angiography, play a critical role in diagnosis, with echocardiography and magnetic resonance imaging providing supplementary insights. Surgical intervention is essential for type A AAD, while type B and IMH cases are generally managed with medical therapy or endovascular repair. PAU cases often require surgical repair if symptomatic. Conclusions: Understanding the distinct pathophysiological mechanisms and timely recognition of AAS subtypes are critical for improving patient outcomes. Early diagnosis and personalized treatment strategies are key in managing this life-threatening condition. Continued advancements in imaging technologies and a better understanding of underlying genetic factors will aid in enhancing diagnosis and optimizing treatment protocols.

Keywords: Acute aortic dissection, intramural hematoma, penetrating aortic ulcer, diagnosis, treatment

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