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Aortic Dissection

Aortic dissection begins with a tear in the intima, allowing blood to penetrate the medial layer and create a false channel. It can be classified by timing (acute, subacute, chronic) and anatomy (Stanford and De Bakey types). Management includes urgent antihypertensive treatment, surgical intervention for Type A dissections, and medical management for Type B dissections, with long-term follow-up necessary.

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8 views3 pages

Aortic Dissection

Aortic dissection begins with a tear in the intima, allowing blood to penetrate the medial layer and create a false channel. It can be classified by timing (acute, subacute, chronic) and anatomy (Stanford and De Bakey types). Management includes urgent antihypertensive treatment, surgical intervention for Type A dissections, and medical management for Type B dissections, with long-term follow-up necessary.

Uploaded by

muhainixd
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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layers of a blood vessel (Tunica intima, Tunica media, and Tunica externa)

Aortic dissection

usually begins with a tear in the intima. Blood penetrates the diseased medial layer,
then cleaves the intimal laminal plain, leading to dissection.
tear in the Intima: The process begins with a rupture in the innermost layer of the aorta.
Blood Penetration: Blood seeps into the middle layer of the aorta.
Dissection Formation: This leads to a split between the layers, creating a false channel
Predisposition: alongside the true channel of blood flow.

• Autoimmune rheumatic disorders and


• Marfan’s syndrome
• Ehlers–Danlos syndrome

Classification (timing of diagnosis from the origin of symptoms):

• Acute < 2 weeks


• Subacute 2–8 weeks
• Chronic > 8 weeks

Classification (anatomically):

Stanford type:

Type A involves the aortic arch and aortic valve proximal to the left subclavian artery
origin

Type B involves the descending thoracic aorta distal to the left subclavian artery origin

De Bakey type:

Type I: extends to the abdominal aorta

Type II: localized to the ascending aorta

Type III: descending thoracic aorta distal to the left subclavian artery origin
Symptoms:

Sudden onset of severe and central chest pain that often radiates to the back and down
the arms, mimicking MI.

The pain is often described as tearing in nature and may be migratory.

Signs:

• Shock
• Neurological symptoms
• Aortic regurgitation
• Coronary ischaemia
• Cardiac tamponade
• Peripheral pulses may be absent

Distal extension:

acute kidney failure, acute lower limb ischaemia or visceral ischaemia


Investigations:

Widened mediastinum on chest X- ray

Urgent CT scan

TOE or MRI will confirm the diagnosis

Management

Urgent antihypertensive medication to reduce blood pressure to below 120 mmHg (50%
are hypertensive)

Intravenous beta-blockers (labetalol, metoprolol) and vasodilators (GTN)

Type A dissections should undergo surgery (arch replacement)

If the patient is fit enough, medical management has high mortality

Type B dissections managed medically (better prognosis)

Unless they develop complications

Endovascular intervention with stents may be indicated in individuals with rapidly


expanding dissections (>1 cm/year), critical diameter (>5.5 cm), refractory pain or
malperfusion syndrome, blunt chest trauma, penetrating aortic ulcers or IMH Aortic intra-mural hematoma

Patients will require long-term follow-up with CT or MRI

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