Vascular

Question 1

What sequence of changes occur in the vessel wall in aortic dissection?

Answer 1

Intimal tear into media of aorta, strips along laminar planes, formation of blood-filled channel within the media, which may then rupture outwards.

Question 2

What are the risk factors for aortic dissection?

Answer 2

Men aged 40-60 with Hypertension

Marfans

Complication of arterial cannulation

Trauma

Question 3

What are the types of aortic dissection?

Answer 3

Type A: ascending aorta involved

Type B: only the thoracic aorta is involved

DeBakey I: ascending + descending aorta

DeBakey II: ascending only

DeBakey III: descending only

Question 4

Describe the pathogenesis of aortic dissection, starting from the predisposing features.

Answer 4

• Medial weakness
• Cystic medial degeneration
• Intimal tear
• Strips along laminar planes, dissecting the media
• Medial haematoma

Question 5

What are the potential consequences of aortic dissection?

Answer 5

• Rupture through adventitia
• Cardiac tamponade (due to rupture into pericardial cavity)
• AMI
• Extension into branches of aorta causing ischaemia to kidneys / bowel / etc