How one systemic crisis became a global movement for change.
A manifesto for prevention and policy. For emergency medicine and imaging. For surgery and critical care. For trainees and researchers. For patients and families. For every person and system involved in aortic care.
Aortic dissection is not only a diagnostic emergency. It is a continuous challenge under time pressure. And the clock does not start where most people think it does.
Most imagine the decisive moment happens in theatre — the chest open, bypass humming, the surgeon standing at the table with instruments in hand. That is the visible drama. It is not always where the outcome is decided.
The challenge begins years before the tear: in the family history never written, the aorta never measured, the relative who will walk into an emergency department in five years with no warning.
It begins again at 3:15am, when a patient wakes with sudden tearing chest pain and no pathway is waiting. No protocol strong enough. No system fast enough for a disease that moves without mercy.
A patient is walking into an emergency department with tearing chest pain. They will describe it in ways that do not fit the textbook. The pain is real. The diagnosis they receive is not.
And too often, we have built too little to stop each one.
Act I — Before the tear ever happens. A first-degree relative carries a 6.7-fold higher aneurysm risk — and a 9.2-fold higher dissection risk. Yet the aorta may remain unmeasured until catastrophe makes it visible. Heritability of dissection is 57% — more inherited than acquired.
Act II — During the crisis. A radiologist sees the scan. But the surgeon does not know yet — 20 minutes pass. A surgeon knows the diagnosis. But the accepting centre is not ready — 30 minutes pass. An accepting centre is ready. But the anaesthetist is not yet informed — 15 minutes pass.
Act III — After survival. At least 23% of Type A survivors screen positive for PTSD. Only 7% are ever diagnosed. Only 9.6% of dissection survivors are fully concordant with surveillance imaging in the first year. The aorta is remodelling. The system is not watching.
Aortic services are not truly tested in grand rounds or annual reports. They are tested at 3am, when one tired clinician, one incomplete story, one delayed scan, one uncertain transfer, or one unavailable team decides whether the patient moves now or waits.
We have tried both goodwill and endurance. We know where they lead — to the medico-legal review, the coroner's report, the family who will never stop asking why.
In medico-legal reviews of missed dissections, the pattern is rarely bad doctors making bad decisions. It is predictable: atypical presentations, diagnostic anchoring, misinterpreted tests, communication breakdowns, services stretched beyond capacity. This symposium chooses the second path — the aorta does not respect specialty borders.
Most conferences pick a discipline and go deep.
This one picks a disease and goes wide.
From prevention to presentation. From pain to scan. From scan to surgeon.
From surgeon to survival. From survival to a life worth the rescue.
From the index patient to the family tree.
From one country's lesson to every country's standard.
The next advance in aortic care will not be one new device, one new scan, one new threshold, one new guideline.
One that recognises faster, transfers smarter, operates safely at 3am on a Sunday, protects the person as well as the organs, finds families before the next emergency, and learns from harm before it must be heard in court.
The paramedic and emergency physician at the start. The radiologist and surgeon at the centre. The intensivist and the family rebuilding after. The policymaker and the patient. The student and the mentor.
Fully cited. Stress-tested.
The cases that haunt you. The near-misses that taught you.
The gaps you see in your own pathway.
Its barriers, its resources, its solutions.
