aetiology and risk factors
Last reviewed 07/2023
Aetiolgy of aortic dissection is multifactorial. Both acquired degenerative disease and inherited susceptibility are thought to be responsible.
Important risk factors for aortic dissection include:
- systemic hypertension
- is the most important risk factor and seen in 40-75% of patients as the presenting condition
- connective tissue disorders - inherent weakness of the aortic wall leads to subsequent dissection and is especially important in patients under the age of 40 years
- Marfan’s syndrome
- develops in 20-40% of patients with Marfan's syndrome
- this condition often underlies dissection in teenagers
- Ehlers-Danlos syndrome
- Turners syndrome
- congenital cardiovascular abnormalities
- bicuspid aortic valves
- a cross sectional study has revealed that there is fivefold to 18fold increased risk of dissection in patients with bicuspid aortic valves
- coarctation
- because of its association with hypertension and congenital disorders of the aortic valve
- pregnancy - 50% of dissections in the under 40's are in pregnant women. Most at risk are primiparous women in the last trimester of pregnancy
- cocaine misuse
- iatrogenic
- surgery to the aorta - following aortic cannulation for cardiopulmonary bypass or aortic valve replacement - but uncommon
- dceleration trauma e.g. – accident, fall from a height
- aortic vasculitic disease
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