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A D V E R T I S E M E N T
A D V E R T I S E M E N T
Aortic dissection starts with a tear in the intima, usually due to uncontrolled hypertension and/or structural wall weakness. About 60% of the time, the entry point is in the convex portion of the arch a few centimeters above the coronary sinuses as in this case. Shear forces and expansibility favor this site. About 10% of tears occur in the arch, and 30% in the descending aorta just distal to the left subclavian artery.
A D V E R T I S E M E N T
Aortic dissections were originally classified by DeBakey into types I-III. This classification has been supplanted by the simpler Stanford classification in which any dissection involving the aortic arch is type A. Dissections beginning in the descending aortic segment are termed Type B. change the words "ascending aorta" to aortic arch. Any involvement of the aortic arch is an acute surgical emergency, due to the risk of retrograde rupture into the pericardium and death by tamponade. Therefore, this is the critical consideration in the treatment algorithm. The dissection often takes a spiral course, with multiple reentry points.
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A D V E R T I S E M E N T
The life-threatening complications of ascending aorta dissections include rupture into the pericardium (see cardiac anatomy) or left chest (red arrows), occlusion of the coronary ostia (yellow arrow) and compromise of the aortic valve. There is a rapid increase in type A dissection mortality if there is a failure to diagnose/treat with elapsed time from the onset of symptoms, reaching 50% at 48 hrs, and up to 75% at two weeks. If the patient survives beyond two weeks, the dissection is classified as chronic.
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This page was last modified on 6/25/2000.
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