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What is an aortic dissection?

The aorta is the biggest artery in the body.  It originates from the left ventricle and supplies virtually every part of the body with oxygenated blood.  A dissection is a tear of the innermost layer of tissue of the vessel.  This causes blood to flow into the middle layer of tissue and damages it causing it to become weak.  This is different from a ruptured aorta because there isn’t a hole in the vessel where blood can escape out.  Aortic dissection is often a surgical emergency that requires careful management.

Aortic dissection can be acute or chronic

Acute dissection – Symptoms or dissection occurring within the last 14 days

Chronic dissection – Symptoms or dissection occurring after the 14th day

It is also important to differentiate bewteen omplicated vs. un-complicated aortic dissection

Complicated aortic dissection – patient has developed a rupture, malperfusion syndromes refractory pain or rapid aortic expansion.

Un-complicated – do not exhibit the above features

How do we classify aortic dissections?

We classify aortic dissections based mainly on where the tear is and if/where it propagates.  There are two widely used protocol for classifications; The DeBakey classifications and The Stanford classifications.

The DeBakey Classifications

  • Type I – propagate from the ascending aorta, extend to the aortic arch, and commonly, beyond the arch distally.
  • Type II – confined to the ascending portion of the aorta.
  • Type III – limited to the descending aorta.

The Stanford

  • Stanford type A – involve the ascending aorta
  • Stanford type B – Do not involve the ascending aorta

Below is a third way to classify dissections but only applies to dissections of the descending aorta.

  • Type 1 – no identifiable intimomedial tears in the descending thoracic aorta.
  • Type 2 – one or more intimomedial tears in the descending thoracic aorta and there is no tear at or distal to the level of the celiac artery.
  • Type 3 – intimomedial tears involving the abdominal aorta (with or without concomitant tears in the descending thoracic aorta).
  • Type 4 – intimomedial tears distal to the aortic bifurcation (with or without concomitant tears in the descending thoracic and abdominal aorta).

 

Uri M. Ben-Zur, M.D., F.A.C.C. completed a residency in internal medicine and fellowships in interventional cardiology, clinical cardiology, and clinical electrophysiology.  He currently practices at the The Paulette Tashnek-Wagner Cardiovascular Institute of Greater Los Angeles located in Tarzana, CA.

 

Aortic Dissection. Digital image. Wikipedia. N.p., n.d. Web. <https://www.mdguidelines.com/mitral-valve-prolapsehttp://en.wikipedia.org/wiki/Aortic_dissection>.

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