In the Stanford classification, Type A involves the ascending aorta and may progress to involve the arch and thoracoabdominal aorta. DeBakey Type I involves the ascending aorta, arch, and descending thoracic aorta and may progress to involve the abdominal aorta) DeBakey Type II is limited to the ascending aorta DeBakey Type IIIa involves the descending thoracic aorta distal to the left subclavian artery and proximal to the celiac artery DeBakey Type IIIb involves the thoracic and abdominal aorta distal to the left subclavian artery. Both the DeBakey classification and the Stanford classification are used to separate aortic dissections into those that need surgical repair and those that usually require only medical management. Two classifications are used for aortic dissections the Stanford classification is used more often. There are several systems of classification for aortic dissection based on anatomy or duration of onset of symptoms. Hypertension is more common in those with distal (type B) dissection compared to type A.70 % or more of patients with AD have hypertension.Bicuspid aortic valve increases the chance of ascending aortic dissection.Turner syndrome (due to aortic root dilatation).Genetic disease/connective tissue abnormalities that affect the aorta affects the structure and function of connective tissue/proteins (e.g., collagen and elastin) in the walls of the aorta - Marfan syndrome (more likely to be proximal dissections), Ehlers-Danlos syndrome.Cardiac surgery-especially aortic valve replacement, since aortic regurgitation can cause dilatation and aortic wall weakening.Syphilis (tertiary stage) with aortic involvement due to vasculitis.Pregnancy, especially in the third trimester and in the postpartum period.Blunt chest trauma (e.g., motor vehicle accidents, though they are usually deceleration injuries that more commonly cause a complete aortic transection or iatrogenic trauma (during catheterization or intra-aortic balloon pump counterpulsation). Dissections in younger individuals ages 30–40 are usually associated with genetic or connective tissue diseases such as Marfan syndrome. It is more common in the African American population than whites, similar to hypertension, and Asians have the lowest incidence. Age, male sex, and hypertension confer the most significant risks in adults over 40, but genetic connective tissue diseases increase the risk of AD in younger patients. The age of presentation of AD depends on underlying risk factors. It is more common in men (65%) than women and is often associated with hypertension. EpidemiologyĪortic dissection (AD) is an infrequent occurrence, with new cases reported at 2–3.5 per 100,000 people every year. In severe cases, the aorta can rupture and be fatal. It is a surgical emergency as the dissection causes reduced blood flow to vital organs. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition.Īn aortic dissection occurs due to longitudinal cleavage of the medial layer of the vessel wall, creating a false lumen in the aorta. This article is not intended to substitute for professional medical advice and should not be relied on as health or personal advice. If there is evidence of decreased perfusion to visceral organs or extremities, aneurysm dilation > 5 cm, retrograde extension into the ascending aorta, or intractable pain, then evaluation for endovascular or open repair is required.įor further review of this topic, including links to lectures by specialists in the field, follow this link: Type B or distal dissections (descending aorta) can be managed medically with beta-blockers and calcium channel blockers. All type A or proximal dissections (ascending aorta) are surgical emergencies due to the risk of imminent rupture. Computed tomography is the diagnostic imaging modality of choice. Patients often present with acute, severe chest or back pain, described as “tearing.” Complications arise due to partial occlusion of vital branches of the aorta with reduced blood flow to the brain, visceral organs, and extremities. This tear, often associated with uncontrolled hypertension, allows blood to flow into the medial layer, thus creating a false lumen. Peer Reviewers: Stanley Oiseth 3 Joseph Alpert 4Īffiliations: 1 Suez Canal University 2 Medical Editor at Lecturio 3 Chief Medical Editor at Lecturio 4 Tucson University, ArizonaĪortic dissection is an emergency that occurs due to shearing stress from pulsatile pressure causing a tear in the tunica intima of the aortic wall. Authors: Ahmed Elsherif 1 Michelle Wyatt 2
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |