Aortic Dissection: Imaging and Elements of Endovascular Pretreatment Evaluation

Aortic dissection (AD) is characterized by an intimal flap in the aortic wall that creates a second blood-filled channel in the aortic lumen. AD encompasses various classifications, radiological signs, and diagnostic examinations crucial for accurate diagnosis and therapeutic planning. DeBakey and Stanford classifications delineate AD based on location and extension, guiding therapeutic decisions. Transthoracic and transesophageal echocardiography facilitate real-time assessment of the aorta’s dynamic changes. Chest X-ray allows for the detection of indirect signs of AD; however, its sensitivity and specificity are limited compared to advanced imaging modalities. Aortography allows for the diagnosis of AD based on visualization of the intimal flap; however, this technique is no longer used in the diagnostic process of AD, except during coronary angiography or endovascular surgery. Imaging modalities such as computed tomography angiography and magnetic resonance imaging are pivotal for confirming or excluding AD, providing an accurate three-dimensional comprehensive assessment of the aorta and its arterial branches, and associated complications. This comprehensive diagnostic framework underscores the importance of employing appropriate imaging techniques for timely and accurate diagnosis, crucial for guiding optimal management strategies in AD patients.