Acute aortic syndromes, broadly defined as a disease spectrum encompassing PAU, IMH, and aortic dissection, may be treated with conservative medical therapy or surgical or endovascular intervention, depending on the presentation. The goal of endovascular stent grafting in these conditions is to maintain true lumen patency, prevent aneurysmal degeneration, and, in the case of dissection, seal intimal tears and induce thrombosis in the false lumen [11]. When clinically suspected, acute aortic syndrome requires immediate diagnostic evaluation to exclude an impending vascular catastrophe. Indications for surgical intervention in these conditions include lack of symptomatic improvement with medical therapy, resistant hypertension, rapid expansion of IMH or false lumen, and concern for impending rupture [5,12-15]. It has been shown that nearly 50% of acute aortic syndrome patients will develop a recurrent acute aortic event within 1 to 2 years of initial presentation, underscoring the need for close follow-up in this population [16]. With the exception of trauma, the vast majority of aortic pathologies arise in patients aged 60 to 80 years. Risk factors include male gender, long-standing hypertension, hyperlipidemia, arteriosclerosis, and smoking [17]. However, there are a variety of genetic syndromes and single-gene mutation conditions that confer a higher risk of thoracic aortic aneurysm and dissection in younger patients, including Marfan syndrome (associated with FBN1 mutations), Loeys-Dietz syndrome (associated with TGFB and SMAD mutations), and familial thoracic aorta aneurysm leading to aortic dissections (associated with ACTA2 mutations) [18]. Even when syndromes are not suspected, patients with a bicuspid aortic valve or a strong family history of aortic disease have higher risk of
Thoracic Aortic Aneurysm or Dissection Treatment Planning and Follow Up. Acute aortic syndromes, broadly defined as a disease spectrum encompassing PAU, IMH, and aortic dissection, may be treated with conservative medical therapy or surgical or endovascular intervention, depending on the presentation. The goal of endovascular stent grafting in these conditions is to maintain true lumen patency, prevent aneurysmal degeneration, and, in the case of dissection, seal intimal tears and induce thrombosis in the false lumen [11]. When clinically suspected, acute aortic syndrome requires immediate diagnostic evaluation to exclude an impending vascular catastrophe. Indications for surgical intervention in these conditions include lack of symptomatic improvement with medical therapy, resistant hypertension, rapid expansion of IMH or false lumen, and concern for impending rupture [5,12-15]. It has been shown that nearly 50% of acute aortic syndrome patients will develop a recurrent acute aortic event within 1 to 2 years of initial presentation, underscoring the need for close follow-up in this population [16]. With the exception of trauma, the vast majority of aortic pathologies arise in patients aged 60 to 80 years. Risk factors include male gender, long-standing hypertension, hyperlipidemia, arteriosclerosis, and smoking [17]. However, there are a variety of genetic syndromes and single-gene mutation conditions that confer a higher risk of thoracic aortic aneurysm and dissection in younger patients, including Marfan syndrome (associated with FBN1 mutations), Loeys-Dietz syndrome (associated with TGFB and SMAD mutations), and familial thoracic aorta aneurysm leading to aortic dissections (associated with ACTA2 mutations) [18]. Even when syndromes are not suspected, patients with a bicuspid aortic valve or a strong family history of aortic disease have higher risk of