Who is at risk of dissection or rupture in moderately dilated ascending aorta?

Ascending aortic dissection is a catastrophic medical emergency. Increasing ascending aortic diameter is known to have a profound impact on rupture, dissection and death. Current practice guidelines recommend elective aortic surgery when the ascending aortic diameter reaches 5.5 cm to prevent the fatal complications (1-3). However, the observations from the International Registry of Acute Aortic Dissection (IRAD) have noted that 59% of type A dissection patients had ascending aortic diameter <55 mm at presentation (4). Therefore, it has been suggested that the threshold for elective aortic surgery should be reexamined and predictors other than aortic size should be needed to identify patients at risk of aortic dissection or rupture.