Aortic Dissection

Question 1

Temporal classification of aortic dissection?

Answer 1

• Acute within 14 days of onset of symptoms (worst mortaility)
• subacute 14-90 days
• chronic >90 days

Question 2

Debakey anatomical classification of aortic dissection?

Answer 2

• Type 1: dissection originate in ascending aorta, extends through aortic arch, and continues into descending aorta and or abdominal aorta
• Type 2: originates in and is confined to ascending aorta
• Type 3 a: originate and confined to descending
• Type 3b: descending and variable extents of abdominal aorta

Question 3

Stanford anatomical classification of aortic dissection?

Answer 3

• type A: originate in ascending aorta therefore encompass debakey type 1 and 2 dissections
. Type B: dissection originate in descending aorta distal to origin of left subclavian aorta, distal to brachiocephalic artery

Question 4

Treatment Stanford A dissection?

Answer 4

Prompt graft replacement of the ascending aorta (remove dissected part) due to high risk fatal complications ( aortic rupture, myocardial ischaemia from extension into coronary arteries)

Endovascular better than open

Question 5

Name 4 risk factors aortic dissection

Answer 5

• Age: type A majority, peak 50-60. Type B 60-70.
• ht
• structural abnormalities aortic wall
• male

Question 6

Define and describe pathophysiology aortic dissection

Answer 6

Tear in aortic tunica intima
Blood pool between tunica media and intima, creating false lumen.
Eventually true lumen collapses while false lumen expands.
This leads to impaired distal perfusion

Question 7

Name 7 causes aortic dissection

Answer 7

Chronic hypertension
• stress
• increased blood volume
• coarctation

Weakened aortic wall (malperfusion syndromes )
• marfan
• ehlers - danlos syndrome
• decreased blood flow in vasa vasorum

aneurysms

Question 8

Symptoms aortic dissection? (2)

Answer 8

• pain of acute onset most commonly, in abdomen ( suspect mesenteric vascular compromise ! ) chest or back
• syncope (may indicate presence cardiac tamponade or brachiocephalic vessel involve)

Question 9

Clinical presentation aortic dissection? (2)

Answer 9

• Hypertension, especially type B
• peripheral vascular complications common, especially when aortic arch or thoraco-abdominal aorta involved

Question 10

Diagnosis aortic dissection? (3)

Answer 10

• cxr: widened mediastinum, displacement aortic calcifications, effusions
• CTA best: see true (smaller and continuous ) and false lumen, approximate entry tear sites and plan intervention
• transthoracic echo can be done, but blind spot in distal ascending aorta and arch, thus do trans esophageal echo!
• MRI great but takes too long

Question 11

Treatment Stanford B dissection?

Answer 11

Medical
• beta blockers
• nitroprusside