Two populationbased studies indicated incidences of 2. Acute medical management of acute aortic syndromes including aortic dissection involves controlling pain, and providing antiimpulse therapy in the form of blood pressure lowering and decreasing the velocity of left ventricular contraction, to decrease aortic shear stress and minimize the tendency for the dissection to propagate table 1. An aortic dissection is a tear that occurs between the innermost and middle layers of the aorta. You may need at least 1 month to recover from your aortic dissection repair surgery. Acute aortic dissection is readily diagnosed using ct scanning, with the reported diagnostic accuracy ranging from 88% to 100% 1,2,3. The dissecting hematoma commonly occupies up to 50% and, occasionally, 100% of the aortic circumference, leading to the development of a false lumen or doublebarreled aorta. Once blood enters the lining, it separates the layers of the aortic wall. The estimated incidence is 530 cases per million people per year.
Aortic dissection columbia university department of surgery. The risk of dying can be as high as one to three percent per hour until the patient gets treatment. Aortic dissection describes the condition when a separation has occurred in aortic wall intima, causing blood flow into a new false channel composed of the inner and outer layers of the media. Stanford classification of aortic dissection radiology. An aortic dissection is a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. Types of aortic dissection the aortaa candy caneshaped blood vessel originating in the chest at the top of the heart and extending into the abdomenis the largest artery in the body. Overall, for both types of aortic dissection, the 10year survival rate is more than 60%.
Acute aortic syndrome is an acute, potentially fatal pathology within the wall of the aorta, including aortic dissection, intramural hematoma imh, and. Dissection most commonly occurs with a discrete intimal tear, but can occur without one. Aortic dissection indicates a tear in the inner lining of ones aorta. The diagnosis and management of aortic dissection the bmj. Usually, a dissection is an arterial wall dissection, but rarely it may be a vein wall dissection vwd. Thoracic aortic dissection tad is the most common aortic catastrophe, occurring in approximately 5 to 30 cases per 1 million persons per year. As the tear extends along the wall of the aorta, blood can flow in between the layers of the blood vessel wall dissection. This type of aortic dissection is more prevalent among the population than type b aortic dissection. Current options and recommendations for the treatment of. Nov 09, 2018 aortic dissection essentially features a tear in the intimal layer, followed by the formation and propagation of a subintimal hematoma. This tear helps in the flow of blood from aorta walls instead of staying in the lumen i. Blood surges through the tear, causing the inner and middle layers of the aorta to separate dissect.
This type of aneurysm is most often found in men over age 60 who have at least one or more risk. Type b aortic dissections, treated medically, have an initial death rate of 10%. A classification system for the bicuspid aortic valve with one major category type and two supplementary categories is presented. Choice of therapy ultimately dependson the nature of the dissection. A dissection is a tear within the wall of a blood vessel, which allows blood to separate the wall layers. Aortic dissection is a more common problem than is ruptured abdominal aortic aneurysm. Aas encompass a constellation of lifethreatening medical conditions including classic acute aortic dissection aad, intramural hematoma, and penetrating atherosclerotic aortic ulcer. An earlier classification system, proposed by debakey et al 3, is used similarly to classify aortic dissections into ascending and descending types. Group b dissections do not involve the ascending aorta and include debakey type iii. The following are key points to remember about this update on the diagnosis and management of acute aortic syndromes aas. It usually requires urgent surgery to repair or replace the first segment of. See more ideas about aortic dissection, aortic aneurysm and abdominal aorta.
Aortic dissection ad occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In a previous report we stated that two distinct types of aortic dissection exist, namely, the openedcommunicated type o type which demonstrates communication between the true lumen and the false lumen, and the thrombosed type t type, also known as aortic dissecting hematoma or as intramural hematoma. Update in the management of type b aortic dissection. An aortic dissection is a tear in the lining of the aorta that creates two blood flow channels. A classification system for the bicuspid aortic valve from. Aortic dissection type a and b symptoms, causes, treatment. The latter, in its acute phase, shows no opacification of the false lumen through.
By separating a portion of the wall of the artery a layer of the tunica intima or tunica media, a dissection creates two lumens or passages within the vessel, the native or true lumen. This type of tear is located closer to the heart and can be lifethreatening. Following the high perioperative risk phase in type a dissection, the intermediate. Aortic dissection is caused by an intimal and medial tear in the aorta with propagation of a false lumen within the aortic media. An aortic dissection is an emergency with your aorta, which is the largest blood vessel in your body and the main artery that takes blood from your heart to the rest of your body. Dake md, in comprehensive vascular and endovascular surgery second edition, 2009. Aortic dissection an overview sciencedirect topics.
Dissecting aortic aneurysm an overview sciencedirect. Aortic dissection type a versus type b oxford academic. An aortic dissection is a tear in the inner lining of the aorta. The most typical surgery for aortic dissection is valve sparing root replacement, or the david procedure. Aortic dissection is a lifethreatening condition which may be rapidly fatal if not detected and treated promptly. Aortic dissection open surgery society for vascular surgery.
However, an aortic arch dissection, defined here as either a dissection limited to the aortic arch or a dissection arising distal to the origin of the left subclavian artery and extending. Aortic dissection symptoms, diagnosis and treatment bmj. This system takes into account the location of the original intimal tear and the extent of the dissection. Aortic dissection symptoms, diagnosis and treatment. If you have symptoms of aortic dissection, severe chest pain, symptoms of stroke, call 911 or seek. An aneurysm is a bulge or ballooning in the wall of an artery.
Aortic dissection occurs when a tear occurs in the inner muscle wall lining of the aorta, allowing blood to split apart the muscle layers of the aortic wall symptoms of aortic dissection include a tearing or ripping pain in the chest, sweating, nausea, shortness of breath, weakness, or syncope. Until now, patients have suffered from two major typesforms of aortic dissection referred as typea dissection and type b dissection, defined mainly based on. Arteries are blood vessels that carry oxygenrich blood from the heart to other parts of the body. Aug 23, 2018 aortic dissection indicates a tear in the inner lining of ones aorta. Pathophysiology, diagnosis, and management of aortic dissection. For untreated acute dissection of the ascending aorta, the mortality rate is 12% per hour early after symptom onset. An abdominal aortic aneurysm occurs when the large blood vessel the aorta that supplies blood to the abdomen, pelvis and legs becomes abnormally large or balloons outward. Acute typea aortic dissection ataad is still one of the most challenging diseases that cardiac surgeons encounter. The beak sign and a larger crosssectional area were the most useful indicators of the false lumen for both acute and chronic dissections. If the bloodfilled channel ruptures through the outside aortic wall, aortic dissection is often fatal. It is part of the acute aortic syndrome an umbrella term for aortic dissection, intramural haematoma, and symptomatic aortic ulcer table.
It usually requires urgent surgery to repair or replace the first segment of the aorta ascending aorta where the tear started. A type a aortic dissection is a medical emergency and requires surgery to repair the tear before further damage occurs. Perigraft abscess after debakey type 1 aortic dissection. The symptoms of an aortic dissection can be difficult to distinguish from those of other heart conditions, such as a heart attack chest pain and pain in the upper back are the most common.
An aortic dissection is an emergency with your aorta, which is the largest blood vessel in your body and the main artery that takes blood from your heart to the rest of your body during an. An aortic aneurysm is a weakened or bulging area on the wall of the aorta. One channel is called the true lumen, which feeds blood to most of the important branches of the aorta and is surrounded by the normal aortic lining. It is part of the acute aortic syndromean umbrella term for aortic dissection, intramural haematoma, and symptomatic aortic ulcer table. In patients with acute type a aortic dissection, the most severe form, the.
In most cases, this is associated with a sudden onset of severe chest or back pain, often described as tearing in character. Aortic dissection is a relatively rare but highly lethal disease. Jan 11, 2012 aortic dissection is caused by an intimal and medial tear in the aorta with propagation of a false lumen within the aortic media. Aortic dissection is a serious condition in which there is a tear in the layers within the aortic wall of the major artery carrying blood out of the heart aorta see figures 1, 2 and 3 below.
Aortic dissection, intramural hematoma, penetrating atherosclerotic aortic ulcer part i. Treatment of aortic dissection depends upon the location of the tear. Aug 31, 2016 acute aortic dissection comprises 8595% of all acute aortic pathologies. Causespecific mortality of type b aortic dissection and. The stanford classification divides dissections by the most proximal involvement. Acute aortic dissection and intramural hematoma american. Type a aortic dissection is an aortic dissection that initially occurs in the very first segment of an individuals aorta, the ascending aorta where blood is pushed in an upward direction. This compares to a 25% mortality when treated surgically. Guidelines for the diagnosis and management of patients with. If an aneurysm grows large, it can burst and cause dangerous bleeding or even death. Acute aortic dissection is the most frequent and deadly presentation of acute aortic syndromes.
This classification, even if used in the major category type alone, might be advantageous to better define bicuspid aortic valve disease, facilitate scientific communication, and improve treatment. Typesof aortic dissection debakey and associates divide aortic dissection into threetypes3. Goodin, in aminoffs neurology and general medicine fifth edition, 2014. In addition to coronary and peripheral artery diseases, aortic diseases contribute to the wide spectrum of arterial diseases. Along with the debakey classification, the stanford classification is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management. Patients with type b aortic dissection differ from patients with type a dissection in age, hypertension prevalence. There are two types of aortic dissection repair surgeries done, open and endovascular. Aortic dissection and its variants stanford university. Like other arteries, it carries oxygenrich blood from the heart to the rest of the body. Reprinted with permission from the cleveland clinic foundation. The stanford classification refers to dissections as type.
The stanford classification divides aortic dissection into two groups, a and b group a includes debakey types i and ii and involves the ascending aorta and can propagate to the aortic arch and descending aorta. Update in the management of type b aortic dissection foeke jh nauta1,2, santi trimarchi 1, arnoud v kamman, frans l moll 3, joost a van herwaarden, himanshu j patel4, c alberto figueroa5, kim a eagle 2 and james b froehlich abstract stanford type b aortic dissection tbad is a lifethreatening aortic disease. Aortic dissection management and treatment cleveland clinic. Management of acute aortic dissection and thoracic aortic rupture. Abdominal aortic dissection can present with abdominal pain radiating to the flank or back. Retrospective cohort study of a single health care system of 275 patients with 21 acute type b aortic dissection tbad. A type a tear may extend along the upper part of the aorta and down toward the abdomen. Type a means the dissection involves the ascending aorta, and type b means it involves the. Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. At high pressures, this can lead to a rupture of the aorta, which can be fatal. The aorta is the main artery which branches off the heart and supplies oxygenrich blood to the bodys organs and tissues.
Its incidence is estimated at three to four cases per 100 000 persons per year. Through a sophisticated statistical analysis, the authors properly discuss the various aspects and differences between the two techniques aortic root repair or replacement and clearly. Aortic dissection is caused by an intimal and medial tear in the aorta. Types of aortic dissections university of michigan. As the name suggests, this procedure preserves the aortic valve, attaching it to a graft that replaces the ascending aorta. The thrombosed type of aortic dissectionits clinical. Aortic dissection essentially features a tear in the intimal layer, followed by the formation and propagation of a subintimal hematoma. Pathophysiology of aortic dissection and connective tissue. A affects ascending aorta and arch accounts for 60% of aortic dissections. A multimodal mortality ascertainment and a competing 22 risk model were used to analyze the association of clinical characteristics with aortic and non23 aortic related mortality. The debakey and stanford classifications systems of. Aortic abscess, debakey type 1 aortic dissection, elephant trunk, prosthetic vascular graft infection background agi are rare events with an incidence of about 3% 1, and perigraft abscess is dreaded complications following aortic repair surgeries with high mortality rates. The authors describe dissections that originate from the arch or extend proximally into the arch without the involvement of the ascending aorta which are not adequately accounted for in the stanford nor the debakey classification systems. The goal of the aortic dissection repair surgery is to replacerepair the affected aorta.
Medical management if not complicated type b complications include a decrease. When this inner lining tears, blood escapes from the lumen of the aorta, where blood usually flows, into the lining. Most aneurysms are in the aorta, the main artery that runs from the heart through the chest and. In the above example, if the aortic dissection extended from proximal to the left subclavian artery takeoff to the mid descending aorta, the common iliac arteries would be perfused from the true lumen distal to the dissection but would be at risk for malperfusion due to occlusion of the true lumen of the aorta by the false lumen. Aortic dissection open surgery society for vascular.
In 2014, a special report was published in radiology 4 that recognized an uncommon form of aortic dissection. Dissecting aortic aneurysms, in contrast to nondissecting aortic aneurysms, predominantly involve the thoracic aorta, either at the beginning of the ascending segment type a or immediately distal to the left subclavian artery at the aortic isthmus type b. Type b does not include dissection in the ascending aorta. Type i dissections originate in the ascending aorta and extend to at least the aortic arch. For type a aortic dissection, the mortality rate remains high, with up to a 30% death rate after surgery. If the aortic dissection occurs in the ascending aorta, the curved part of the aorta that extends upward from the heart, its called a type a aortic dissection. The purpose of this study was to determine which ct findings are reliable indicators of the true or false lumen in an aortic dissection.