Aortic dissection risk factors

Aortic dissection Microchapters
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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Aging, atherosclerosis, diabetes, hypertension and trauma are common risk factors for aortic dissection. Uncommon risk factors include Bicuspid aortic valve, cocaine, Coarctation of the aorta, Cystic medial necrosis, Ehlers-Danlos syndrome, Giant cell arteritis, Heart surgery, Marfan’s syndrome, Pseudoxanthoma elasticum, Turner's syndrome, Tertiary syphilis and the third trimester of pregnancy.

Risk Factors

• Aging
• Atherosclerosis and its associated risk factors like diabetes
• Bicuspid aortic valve is present in approximately 7%-14% of patients. These individuals are prone to dissection in the ascending aorta. The risk of dissection in individuals with bicuspid aortic valve is not associated with the degree of stenosis of the valve.
• Cocaine abuse
• Coarctation of the aorta
• Cystic medial necrosis
• Deceleration trauma most commonly causes aortic rupture, not dissection
• Ehlers-Danlos syndrome
• Giant cell arteritis
• Heart surgery particularly aortic valve replacement; 18% of individuals who present with an acute aortic dissection have a history of open heart surgery. Individuals who have undergone aortic valve replacement for aortic insufficiency are at particularly high risk. This is because aortic insufficiency causes increased blood flow in the ascending aorta. This can cause dilatation and weakening of the walls of the ascending aorta.
• Hypertension is seen in 71-86% of patients, occurring most frequently in those with type III dissection
• Marfan’s syndrome is present in 6% of patients
• Pseudoxanthoma elasticum
• Turner's syndrome
• Tertiary syphilis
• Third trimester of pregnancy