Aortic Dissection

Question 1

What are the different classifications of Aortic Dissection?

Answer 1

• Standford Classification
• Debakey Classification

Question 2

What is the Stanford Classification of Aortic Dissection?

Answer 2

Stanford Classification

• Type A - ascending aorta, 2/3 of cases
• Type B - descending aorta, distal to left subclavian origin, 1/3 of cases

Question 3

What is the Debakey Classification?

Answer 3

• Type I - Originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally ​
• Type II - originates in and is confined to the ascending aorta
• Type III - originates in descending aorta, rarely extends proximally but will extend distally

Question 4

What is the management of a Type A Aortic Dissection according to the Stanford Classification?

Answer 4

• Surgical management is definitive treatment
• Blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

Question 5

What is the management of a Type B Aortic Dissection according to the Stanford Classification?

Answer 5

Conservative management

• Bed rest
• Reduce blood pressure with IV labetalol to prevent progression

Question 6

What are complications of a backward tear aortic dissection?

Answer 6

• Aortic incompetence/regurgitation
• MyocardiaI Infarction: inferior pattern often seen due to right coronary involvement

Question 7

What are complications of a forward tear aortic dissection?

Answer 7

• Unequal arm pulses and BP
• Stroke
• Renal failure