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Aetiology and risk factors

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

Reference:


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