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Abstract
Acute aortic syndromes (AAS) encompass a constellation of life-threatening medical
conditions including classic acute aortic dissection (AAD), intramural haematoma,
and penetrating atherosclerotic aortic ulcer. Given the non-specific symptoms and
physical signs, a high clinical index of suspicion is necessary to detect the disease
before irreversible lethal complications occur. In order to reduce the diagnostic
time delay, a comprehensive flowchart for decision-making based on pre-test sensitivity
of AAS has been designed by the European Society of Cardiology guidelines on aortic
diseases and should be thus applied in the emergency scenario. When the definitive
diagnosis is made, prompt and appropriate therapeutic interventions should be undertaken
if indicated by a highly specialized aortic team. Urgent surgery for AAD involving
the ascending aorta (Type A) and medical therapy alone for AAD not involving the ascending
aorta (Type B) are typically recommended. In complicated Type B AAD, thoracic endovascular
aortic repair (TEVAR) is generally indicated. On the other hand, in uncomplicated
Type B AAD, pre-emptive TEVAR rather than medical therapy alone to prevent late complications,
while intuitive, requires further study in randomized cohorts. Finally, it should
be highlighted that there is an urgent need to increase awareness of AAS worldwide,
including dedicated education/prevention programmes, and to improve diagnostic and
therapeutic strategies, outcomes, and lifelong surveillance.