Aortic Size and Aortic Dissection: Does One Size Fit All?

by 7.65 mm, due solely to type A dissection, and the diameter of the descending thoracic aorta increased by 6.38 mm, due solely to type B dissection. Rylski et al. [2] reported similar findings; however, among others, they did not correct aortic diameter for aneurysmal growth at the time of aortic dissection, as did Mansour et al. [1]. This observation, even though it was made in a small number of patients, may obviously have important clinical implications, because indications for interventional therapy (surgical or percutaneous) are mostly based on the size of the aorta at the time of dissection, with only limited information being available for the size of the aorta just prior to this catastrophic event [3–12]. However, it appears that, at least in certain patients, the diameter of the aorta prior to dissection is smaller than the size in clinical practice guidelines that recommend therapeutic intervention [2]. Importantly, the progression of the aortic diameter over time, also taken into consideration for clinical decisions about therapeutic intervention, is not always linear. It is quite plausible that the size of the aorta changes in a linear fashion up to a certain diameter, followed by an acceleration of aortic dilatation in a nonlinear fashion [10, 11]. Variability is the law of life. William Osler