From morphology to risk: contemporary classification systems in acute aortic dissection

Acute aortic dissection is a critical surgical condition that in most cases requires immediate intervention. Despite signifi cant advances in surgical and interventional technologies, repair remains increasingly complex. It is associated with considerable mortality (5-65%, average postoperative mortality 20%) and morbidity (8-80%, 20% on average), which signifi cantly depend on the individual clinical and morphological characteristics of each patient. The need for an individualised multidisciplinary approach in establishing the diagnosis, clarifying the anatomical parameters of the involvement – initial intimal tear, characteristics and extension of the false lumen, involved arterial branches, and clinical indicators for the presence of end-organ malperfusion – are key points in choosing a therapeutic strategy (surgical, medical, endovascular, or hybrid). To facilitate these decisions and systematise the diagnostic and therapeutic approach over the past more than 70 years, as data have accumulated, various classifi cation systems have been proposed based on specifi c characteristics of the disease process and associated risks. Alongside these processes, the need for reliable tools for preprocedural risk assessment and prediction of the fi nal therapeutic outcome has increased signifi cantly. This review aims to present the most widely used classifi cation systems and outcome prediction models for acute aortic dissections, and to examine their role in decision-making.