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

Aortic dissection is associated with hypertension (high blood pressure) and many connective tissue disorders. Vasculitis (inflammation of an artery) is rarely associated with aortic dissection. It can also be the result of chest trauma. 72 to 80% of individuals who present with an aortic dissection have a previous history of hypertension.

The highest incidence of aortic dissection is in individuals who are 50 to 70 years old. The incidence is twice as high in males as in females (male-to-female ratio is 2:1). Half of dissections in females before age 40 occur during pregnancy (typically in the 3rd trimester or early postpartum period).

Marfan syndrome is noted in 5-9% of individuals who suffer from aortic dissection. In this subset, there is an increased incidence in young individuals. Individuals with Marfan syndrome tend to have aneurysms of the aorta and are more prone to proximal dissections of the aorta.

Turner syndrome also increases the risk of aortic dissection, by aortic root dilatation.

Chest trauma leading to aortic dissection can be divided into two groups based on etiology: blunt chest trauma (commonly seen in car accidents) and iatrogenic. Iatrogenic causes include trauma during cardiac catheterization or due to an intra-aortic balloon pump.