36. Diseases of the Aorta

Diseases of the aorta can affect any segment of the aorta or its branch vessels, may exhibit diverse and at times nonspecific protean manifestations, and might be chronic and indolent but also have the potential to present with acutely lethal consequences. Accordingly, it is imperative that both internists and cardiologists are familiar with principles of emergent management of aortopathies as well as of screening for these conditions, since detection and prophylactic treatment of diseases of the aorta will generally improve patient outcomes. Aortic aneurysms represent dilatation of all three layers of the vessel wall and may cause mass effects or progress toward dissection and/or rupture. Acute aortic dissections require prompt diagnosis and expert medical and interventional management. Endovascular techniques have become an adjunct to traditional open surgical repairs and may be utilized for select patient populations and scenarios, though comparative and long-term outcomes of the endovascular approach remain under investigation. Genetic and molecular techniques are elucidating novel pathophysiologic bases underlying diseases of the aorta and may reveal future therapeutic targets that can prevent or reverse aortopathy.