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Page 2 of 19 Rinaldi et al. Vessel Plus 2024;8:21 https://dx.doi.org/10.20517/2574-1209.2023.65

disorders that encompass a diverse range of patients with similar clinical features but different underlying
diseases, including aortic rupture, aortic dissection (AD), intramural hematoma (IMH), and ulcerative
[1]
aortic lesions (PAU) . Despite their distinctive nature, these conditions are grouped together due to the
presence of comparable symptoms, and distinguishing between these pathological scenarios can sometimes
be challenging .
[2,3]
The primary clinical manifestation of AAS typically involves intense, abrupt chest and/or back pain.
Nevertheless, individuals affected by AAS may display a diverse array of symptoms including abdominal
pain, episodes of fainting, and diminished or absent pulse in the legs or feet. AAS presents a substantial
threat to life, with mortality rates potentially soaring to 40%-50%; hence, timely identification of AAS
patients is paramount, as is the ability to differentiate between AAS and other conditions sharing similar
[1-4]
clinical features but associated with lower morbidity and mortality rates .
The management of AAS involves a comprehensive approach encompassing medical, surgical, and
endovascular interventions. Over the past three decades, the introduction of endovascular techniques has
fundamentally altered the treatment landscape for acute aortic syndromes affecting the descending thoracic
aorta. This period has witnessed a notable shift away from open surgical approaches, with a steady rise in
the utilization of complete endovascular management. This review article will discuss the various
pathologies included in the AAS group and explore the current advancements in endovasculartherapies.
Description, results, and considerations regarding the contemporary treatment of the acute aortic
syndromes have been liberally extrapolated by the authors of this review article from position papers and
from the updated literature in this field.

aTBAD - acute type B aortic dissection
Aortic dissection can be a devastating event that leads to a diverse spectrum of clinical presentations;the
particular impacts encountered by individuals are directly correlated with the distribution and magnitude of
aortic and branch vessel involvement.

Classification systems for thoracic aortic dissection play a crucial role in facilitating rapid and accurate
communication among caregivers for describing aortic diseases, thereby aiding in triage, treatment, and
prognostic assessments. From an anatomical perspective, early experiences revealed distinct differences
between patients with dissection of the ascending aorta, which carries a worse immediate prognosis, and
those with dissection of the descending aorta . Recognizing this differentiation, two commonly referenced
[5-8]
classification systems, namely the DeBakey and Stanford classifications, emphasized the importance of
[6,9]
distinguishing between these two types of dissection . These schemes have been widely adopted and are
generally well understood, particularly in the context of determining whether open surgical repair or
conservative medical therapy is necessary. However, it is important to note that these classification systems
were developed before the advent of advanced diagnostic imaging techniques and during a time of limited
therapeutic options. Historically, these systems relied on identifying the anatomical location of intimal entry
tears and the longitudinal extent of the dissection flap. The original DeBakey classification categorized
aortic dissection based on anatomical features, while the more widely embraced Stanford classification
simplified this approach. However, the Stanford classification lacks characterization of the distal extent of
dissection, and neither system addresses aortic dissections originating in the arch. Recognizing these
shortcomings, novel classification systems have recently emerged to delineate aortic arch involvement more
precisely, and to provide a more nuanced description of the condition.