Type A Dissection Flashcards
What occurs in an aortic dissection?
There is an intimal tear allowing blood to go between the medial and intimal layers
What is the Stafford Classification of aortic dissections?
Type A = ascending aorta involved; Type B = only descending thoracic aorta and below are involved (may involve the arch though)
What is the mortality rate without surgery with a Type A dissection?
1-2% per hour for the first 48 hours; 74% by 2 weeks
How are dissections characterized via timing?
Hyperacute = <24 hours, Acute = 1 day to 2 weeks, Subacute = 2 weeks to 3 months, Chronic = > 3 months
What is the incidence rate for acute aortic dissections?
3 cases per 100,000 per year
What are risk factors for aortic dissection?
Male + connective tissue disorders (Marfan, Ehlers-Danlos, Loeys-Dietz) + bicuspid AV + Aortic coarctation + HTN
Do men or women have worse outcomes?
Women typically have worse outcomes because of delayed diagnosis due to atypical symptoms
What is the DeBakey classification of aortic dissections?
Type I = originates in ascending aorta and propagates distally into the descending aorta; Type II = originates in ascending and confined to the ascending only; Type IIIa = originates in the descending thoracic and confined to descending thoracic; Type IIIb = originates in descending and propagates below the diaphragm
What is the SVS/STS classification system for aortic dissections?
Based on the location of the intimal tear and the proximal and distal extent of the dissection; Zones 0-12 where Zone 0 is the ascending aorta up to innominate artery, Zone 1 is from innominate to left carotid, Zone 2 is from left carotid to left subclavian, etc.
What is a Type A(d) dissection based on the SVS/STS classification system?
The aortic dissection originates in the ascending aorta and goes distally to d (tells us where the distal zone is)
What is a Type B(pd) dissection based on the SVS/STS classification system?
The aortic dissection originates from Zone 1 or below (p will tell you where the proximal zone is and d tells you where the distal zone is)
What is a Type I(d) dissection based on the SVS/STS classification system?
Indeterminate location for the entry tear and the dissection extends distally to zone d (whatever zone that is)
What should be measured in patients with suspected aortic disease based on 2022 ACC/AHA guidelines?
Aortic diameters (longest diameter and its perpendicular diameter at a reproducible anatomic landmark) + root and ascending aortic diameters from edge to edge using ECG synchronized technology
Where should you put your arterial line in type A dissections?
Right radial monitors flow to the innominate artery; if axillary cannulation is performed, then left radial artery pressures are needed; sometimes femoral pressures are needed for distal aortic perfusion sensing
What neuromonitoring can you do in Type A dissections?
EEG (for deep hypothermic circulatory arrest) + SSEP/MEP + cerebral oximetry
