Aortic dissection Flashcards
What is aortic dissection
Blood enters between intimacy and media layers of aorta
Which part of the aorta is most commonly affected
Ascending and aortic arch
What are the two classification systems
Stanford and Debakey
Explain the Stanford classification system
Type A - ascending aorta before brachiocephalic artery
Type B - descending aorta, after left subclavian artery
Explain the Debakey classification system
Type I – begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta
Type II – isolated to the ascending aorta
Type IIIa – begins in the descending aorta and involves only the section above the diaphragm
Type IIIb – begins in the descending aorta and involves the aorta below the diaphragm
What are risk factors
Those of PAD
HTN especially
Conditions affecting the aorta - bicuspid aortic valve, coarctation, aortic valve replacement, CABG
Conditions affecting connective tissues - Ehlers-Danlos syndrome, Marfans
What is the typical presentation
Sudden onset severe ripping or tearing chest pain
What other features may suggest aortic dissection
HTN
Differences in blood pressure between arms >20mmHg
Radial pulse deficit
Diastolic murmur
Focal neuro deficit
Chest AND abdo pain
Collapse
Hypotension
What investigations would you do
ECG and CXR to exclude other causes
CT angiogram
MRI angiogram for greater detail
What is treatment of type A
Open surgery to remove the section of the aorta with the defect in the wall and replace it with a synthetic graft
What is the management of type B
Thoracic endovascular aortic repair
Catheter inserted via the femoral artery inserting a stent graft into the affected section of the descending aorta
What are the complications of dissection
MI
Stroke
Paraplegia
Cardiac tamponade
AV regurgitation
Death
