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Aorta Dissection Background Classic aortic dissection is a longitudinal split or partition in the media of the aorta. The smaller true lumen is lined by intima, and the false lumen is lined by media. The dissection usually stops at an aortic branch vessel or at the level of an atherosclerotic plaque. pathophysiology Most classic aortic dissections anatomic locations the aortic root 2 cm above the aortic root just distal to the left subclavian artery Common reasons of causing death wall rupture hemopericardium and tamponade occlusion of the coronary ostia with myocardial infarction severe aortic insufficiency. Aortic intramural hematoma (AIH) a more recently described entity in which no intimal flap is present ; It results in a spontaneous medial hematoma that may be secondary to an infarction of the vasa vasorum of the adventitia. Aortic intramural hematoma accounts for approximately 25% of aortic dissections. Involvement of the ascending aorta, associated risk factors Chronic hypertension Connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome) Bicuspid aortic valve Coarctation of the aorta Turner syndrome Takayasu arteritis Giant cell arteritis Pregnancy Trauma Crack cocaine use Cardiac catheterization Metabolic disorders Mortality/Morbidity The mortality rate increases with a delay in diagnosis, especially for ascending aortic dissections. The mortality rate is 1% per hour for the first 48 hours. The incidence is approximately 2000 cases per year. lack of reporting and the small number of autopsies performed grossly underestimate the true incidence. Sex,age and race Aortic dissections are more common in men than in women (ratio, 3:1) ; in patients aged 35-85 years, with a peak in those aged 50-65 years.; Aortic dissection is more common in African-Americans; It is least common in Asians. classification DeBakey classification Type I: The entire aorta is involved. Type II: Only the ascending aorta is involved.