Aortic dissection overview
|
Aortic dissection Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Special Scenarios |
|
Case Studies |
|
|
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Aortic dissection is a tear in the wall of the aorta that causes blood to flow between the layers of the wall of the aorta and force the layers apart. Aortic dissection is a medical emergency and can quickly lead to death, even with optimal treatment. If the dissection tears the aorta completely open (through all three layers) massive and rapid blood loss occurs. Aortic dissections resulting in rupture have a 90% mortality rate even if intervention is timely.
Acute aortic dissection is the most common fatal condition that involves the aorta. The mortality rate has been estimated to be as high as 1% per hour during the first 48 hours. Because of the diverse clinical manifestations of aortic dissection, one needs to maintain a high index of suspicion in patients with not just chest pain, but also those with stroke, congestive heart failure, hoarseness, hemoptysis, claudication, superior vena cava (SVC) syndrome, or upper airway obstruction. Despite the fact that a noninvasive diagnosis can be made in up to 90% of cases, the correct antemortem diagnosis is made less than 50% of the time. Recognition of the condition and vigorous pre-operative management are critical to survival.
Classification
Several different classification systems have been used to describe aortic dissections. The systems commonly in use are either based on either the anatomy of the dissection (proximal, distal) or the duration of onset of symptoms (acute, chronic) prior to presentation.
DeBakey classification system
The DeBakey system is an anatomical description of the aortic dissection. It categorizes the dissection based on where the original intimal tear is located and the extent of the dissection (localized to either the ascending aorta or descending aorta, or involves both the ascending and descending aorta.[1]
- Type I - Originates in ascending aorta, propagates at least to the aortic arch and often beyond it distally.
- Type II – Originates in and is confined to the ascending aorta.
- Type III – Originates in descending aorta, rarely extends proximally.
|
|
| |
| Percentage | 60 % | 10-15 % | 25-30 % |
| Type | DeBakey I | DeBakey II | DeBakey III |
| Stanford A | Stanford B | ||
| Proximal | Distal | ||
| Classification of aortic dissection | |||
Stanford Classification System
Divided into 2 groups; A and B depending on whether the ascending aorta is involved.[2]
- A = Type I and II DeBakey
- B = Type III Debakey
Epidemiology and Demographics
There are approximately 2000 cases of aortic dissection in the US per year, and aortic dissection accounts for 3-4% of sudden deaths. The peak incidence is in the sixth and seventh decades, and males predominate 2:1.
Risk Factors
Aging, atherosclerosis, diabetes, hypertension and trauma are common risk factors for aortic dissection. Uncommon risk factors include Bicuspid aortic valve, cocaine, Coarctation of the aorta, Cystic medial necrosis, Ehlers-Danlos syndrome, Giant cell arteritis, Heart surgery, Marfan’s syndrome, Pseudoxanthoma elasticum, Turner's syndrome, Tertiary syphilis and the third trimester of pregnancy.
References
- ↑ DeBakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg 1965;49:130-49. PMID 14261867.
- ↑ Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg 1970;10:237-47. PMID 5458238.