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 Aortic Dissection:

Aortic Dissection represents a spectrum of processes in which blood  enters the muscular layer of the aortic wall and splits it in a longitudinal fashion.
Most are spontaneous and occur in the setting of acquired or inherited degeneration of the aortic media.
Spontaneous dissections almost exclusively originate in the thoracic aorta and secondarily involve the abdominal aorta by extension from above.
Aortic dissection results in the separation of two lumens by an intimal flap.

Clinical Signs/Symptoms of AD:

  • Chest Pain or back pain, 80-90%
  • Aortic Insufficiency
  • Blood Pressure discrepancies between extremities
  • Neurologic deficits
  • Ischemic Extremity
  • Pulse Deficits
  • Silent Dissections are VERY RARE

Causes:

  • HTN (most common)
  • Structural Collagen Disorders (Marfan syndrome, Ehlers-Danlos syndrome)
  • Congenital (aortic coarc, bicuspid or unicuspid valve)
  • Pregnancy
  • Collagen Vascular Disease (very uncommon)

Types:

Debakey and Stanford Classifications:

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Stanford Classification:

  • Type A, 60%; involves at least ascending aorta, surgical treatment
  • Type B, 40%, limited to descending aorta, medical treatment

Deakley Classification:

  • Type I, 50%; involves ascending and descending aorta
  • Type II, 10%; confined to ascending aorta
  • Type III, 40%; same as Stanford B

Treatment:

  • Stanford B: medical control is standard. Surgery indicated in complicated type B dissections (ischemic injury, renal artery compromise, rupture, aneurysmal enlargement of false lumen)
  • Stanford A: requires surgery because of involvement of aortic root.
    • Pericardial tamponade
    • Coronary artery occlusion
    • Aortic insufficiency

Interesting info:

  • Differentiation of true an false lumen
    • False lumen is anterolateral in ascending aorta and posterolateral in descending  aorta
    • CXR is normal in 25% of cases

Further examples:

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