Acute aortic dissection – vascular emergency with numerous pitfalls

Acute aortic syndrome comprises acute aortic dissection, aortic intramural haematoma and penetrating atherosclerotic ulcers of the aortic wall. It ranks, after acute coronary syndrome, as one of the most frequent acute life-threatening differential diagnoses of chest pain. Chances of survival would probably be good in the large majority of cases, assuming optimal therapeutic management including rapid diagnostic evaluation followed by immediate and appropriate treatment is provided. However, actual mortality rate in these patients is still currently higher than 40%, despite medical and surgical progress. This unfavourable prognosis for the most frequent variant of acute aortic syndrome – aortic dissection – is due to the wide variability of clinical symptoms. These are often initially unspecific and frequently lead to delays in establishing the correct diagnosis, possibly first recognised at autopsy. Even after a timely, correct diagnosis, there is still a considerably high mortality rate following surger...