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| ! style="background: #FFFF00; width: 150px;" | Recomendacations !! style="background: #FFFF00; width: 150px;" | Class !! style="background: #FFFF00; width: 150px;" | Level !! style="background: #FFFF00; width: 150px;" | References
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| ! colspan="4" align="left" |History and clinical assessment
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| ! style="padding: 5px 5px; background: #FFFFE0; " align="left" |In all patients with suspected
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| AAS, pre-test probability
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| assessment is recommended,
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| according to the patient’s
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| condition, symptoms, and
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| clinical features.
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| | style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
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| | style="padding: 5px 5px; background: #0000CD;" align="center" |'''B'''
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| |" align="center" |<ref name="EvangelistaIsselbacher2018">{{cite journal|last1=Evangelista|first1=Arturo|last2=Isselbacher|first2=Eric M.|last3=Bossone|first3=Eduardo|last4=Gleason|first4=Thomas G.|last5=Eusanio|first5=Marco Di|last6=Sechtem|first6=Udo|last7=Ehrlich|first7=Marek P.|last8=Trimarchi|first8=Santi|last9=Braverman|first9=Alan C.|last10=Myrmel|first10=Truls|last11=Harris|first11=Kevin M.|last12=Hutchinson|first12=Stuart|last13=O’Gara|first13=Patrick|last14=Suzuki|first14=Toru|last15=Nienaber|first15=Christoph A.|last16=Eagle|first16=Kim A.|title=Insights From the International Registry of Acute Aortic Dissection|journal=Circulation|volume=137|issue=17|year=2018|pages=1846–1860|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.031264}}</ref>
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| ! colspan="4" align="left" | Laboratory testing
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| ! style="padding: 5px 5px; background: #FFFFE0; " align="left" |In case of suspicion of AAS,
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| the interpretation of
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| biomarkers should always be
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| considered along with the pretest
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| clinical probability.
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| | style="padding: 5px 5px; background: #FFFACD;" align="center" |'''IIa'''
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| | style="padding: 5px 5px; background: #0000CD;" align="center" |'''B'''
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| ! style="padding: 5px 5px; " align="left" |In case of low clinical
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| probability of AAS, negative D-dimer
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| levels should be
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| considered as ruling out the
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| diagnosis.
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| | style="padding: 5px 5px; background: #FFFACD;" align="center" |'''IIa'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| | align="center" |<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref><ref name="SuzukiBossone2013">{{cite journal|last1=Suzuki|first1=Toru|last2=Bossone|first2=Eduardo|last3=Sawaki|first3=Daigo|last4=Jánosi|first4=Rolf Alexander|last5=Erbel|first5=Raimund|last6=Eagle|first6=Kim|last7=Nagai|first7=Ryozo|title=Biomarkers of aortic diseases|journal=American Heart Journal|volume=165|issue=1|year=2013|pages=15–25|issn=00028703|doi=10.1016/j.ahj.2012.10.006}}</ref><ref name="TaylorIyer2013">{{cite journal|last1=Taylor|first1=R. Andrew|last2=Iyer|first2=Neel S.|title=A decision analysis to determine a testing threshold for computed tomographic angiography and d-dimer in the evaluation of aortic dissection|journal=The American Journal of Emergency Medicine|volume=31|issue=7|year=2013|pages=1047–1055|issn=07356757|doi=10.1016/j.ajem.2013.03.039}}</ref>
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| ! style="padding: 5px 5px; background: #FFFFE0; " align="left" |In case of intermediate clinical
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| probability of AAS with a
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| positive (point-of-care) D-dimer
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| test, further imaging
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| tests should be considered.
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| | style="padding: 5px 5px; background: #FFFACD;" align="center" |'''IIa'''
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| | style="padding: 5px 5px; background: #0000CD;" align="center" |'''B'''
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| | align="center" |<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref>
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| ! style="padding: 5px 5px;" align="left" |In patients with high probability
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| (risk score 2 or 3) of AD,
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| testing of D-dimers is not
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| recommended.
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| | style="padding: 5px 5px; background: #F08080;" align="center" |'''III'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| |-
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| ! colspan="4" align="left" |Imaging
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| ! style="padding: 5px 5px; background: #FFFFE0; " align="left" |TTE is recommended as an
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| initial imaging investigation.
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| | style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| !
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| ! style="padding: 5px 5px; " align="left" |In unstabled patients with a
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| suspicion of AAS, the following
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| imaging modalities are
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| recommended according to
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| local availability and expertise:
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| !
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| !
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| !
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| |-
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| !TOE
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| | style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| !
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| |-
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| !CT
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| | style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| !
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| |-
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| ! style="padding: 5px 5px; background: #FFFFE0; " align="left" |In stable patients with a
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|
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| suspicion of AAS, the
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|
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| following imaging modalities
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|
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| are recommended (or should
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| be considered) according to
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|
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| local availability and expertise:
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| !
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| !
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| !
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| |-
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| !CT
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| | style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| !
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| |-
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| !MRI
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| | style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| !
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| |-
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| !TOE
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| | style="padding: 5px 5px; background: #FFFACD;" align="center" |'''IIa'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| !
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| |-
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| ! style="padding: 5px 5px; background: #FFFFE0; " align="left" |In case of initially negative
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|
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| imaging with the persistence of
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| suspicion of AAS, repetitive
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|
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| imaging (CT or MRI) is
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|
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| recommended.
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| | style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| !
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| |-
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| ! style="padding: 5px 5px;" align="left" |Chest X-ray maybe
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|
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| considered in cases of low
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|
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| clinical probability of AAS.
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| | style="padding: 5px 5px; background: #FFFACD;" align="center" |'''IIb'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| !
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| |-
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| ! style="padding: 5px 5px; background: #FFFFE0;" align="left" |In case of uncomplicated
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|
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| Type B AD treated medically,
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|
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| repeated imaging (CT or
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|
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| MRI)e during the first days is
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|
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| recommended.
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| | style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
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| | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C'''
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| !
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| |}
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