Aortic dissection resident survival guide: Difference between revisions
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==Classification== | ==Classification== | ||
Aortic dissection can be classified into four types .DeBakey and Daily (Stanford) systems are the commonly used systems used to classify aortic dissection.<ref name="Nienaber-2003">{{Cite journal | last1 = Nienaber | first1 = CA. | last2 = Eagle | first2 = KA. | title = Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. | journal = Circulation | volume = 108 | issue = 5 | pages = 628-35 | month = Aug | year = 2003 | doi = 10.1161/01.CIR.0000087009.16755.E4 | PMID = 12900496 }}</ref><ref name="Tsai-2005">{{Cite journal | last1 = Tsai | first1 = TT. | last2 = Nienaber | first2 = CA. | last3 = Eagle | first3 = KA. | title = Acute aortic syndromes. | journal = Circulation | volume = 112 | issue = 24 | pages = 3802-13 | month = Dec | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.534198 | PMID = 16344407 }}</ref><ref name="DEBAKEY-1965">{{Cite journal | last1 = DEBAKEY | first1 = ME. | last2 = HENLY | first2 = WS. | last3 = COOLEY | first3 = DA. | last4 = MORRIS | first4 = GC. | last5 = CRAWFORD | first5 = ES. | last6 = BEALL | first6 = AC. | title = SURGICAL MANAGEMENT OF DISSECTING ANEURYSMS OF THE AORTA. | journal = J Thorac Cardiovasc Surg | volume = 49 | issue = | pages = 130-49 | month = Jan | year = 1965 | doi = | PMID = 14261867 }}</ref><ref name="Daily-1970">{{Cite journal | last1 = Daily | first1 = PO. | last2 = Trueblood | first2 = HW. | last3 = Stinson | first3 = EB. | last4 = Wuerflein | first4 = RD. | last5 = Shumway | first5 = NE. | title = Management of acute aortic dissections. | journal = Ann Thorac Surg | volume = 10 | issue = 3 | pages = 237-47 | month = Sep | year = 1970 | doi = | PMID = 5458238 }}</ref> | Aortic dissection can be classified into four types. DeBakey and Daily (Stanford) systems are the commonly used systems used to classify aortic dissection.<ref name="Nienaber-2003">{{Cite journal | last1 = Nienaber | first1 = CA. | last2 = Eagle | first2 = KA. | title = Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. | journal = Circulation | volume = 108 | issue = 5 | pages = 628-35 | month = Aug | year = 2003 | doi = 10.1161/01.CIR.0000087009.16755.E4 | PMID = 12900496 }}</ref><ref name="Tsai-2005">{{Cite journal | last1 = Tsai | first1 = TT. | last2 = Nienaber | first2 = CA. | last3 = Eagle | first3 = KA. | title = Acute aortic syndromes. | journal = Circulation | volume = 112 | issue = 24 | pages = 3802-13 | month = Dec | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.534198 | PMID = 16344407 }}</ref><ref name="DEBAKEY-1965">{{Cite journal | last1 = DEBAKEY | first1 = ME. | last2 = HENLY | first2 = WS. | last3 = COOLEY | first3 = DA. | last4 = MORRIS | first4 = GC. | last5 = CRAWFORD | first5 = ES. | last6 = BEALL | first6 = AC. | title = SURGICAL MANAGEMENT OF DISSECTING ANEURYSMS OF THE AORTA. | journal = J Thorac Cardiovasc Surg | volume = 49 | issue = | pages = 130-49 | month = Jan | year = 1965 | doi = | PMID = 14261867 }}</ref><ref name="Daily-1970">{{Cite journal | last1 = Daily | first1 = PO. | last2 = Trueblood | first2 = HW. | last3 = Stinson | first3 = EB. | last4 = Wuerflein | first4 = RD. | last5 = Shumway | first5 = NE. | title = Management of acute aortic dissections. | journal = Ann Thorac Surg | volume = 10 | issue = 3 | pages = 237-47 | month = Sep | year = 1970 | doi = | PMID = 5458238 }}</ref> | ||
*Stanford system classifies dissection into the following two types based on whether ascending aorta is involved or not. | *Stanford system classifies dissection into the following two types based on whether ascending aorta is involved or not. | ||
#Ascending aortic dissection or type A | #Ascending aortic dissection or type A | ||
Line 16: | Line 16: | ||
*DeBakey system classifies dissection according to location of the tear. | *DeBakey system classifies dissection according to location of the tear. | ||
#Type I- Starts at ascending aorta and extension upto the aortic arch | #Type I- Starts at ascending aorta and extension upto the aortic arch | ||
#Type II- Starts and is limited till the ascending aorta | #Type II- Starts and is limited till the ascending aorta | ||
#Type III- Starts in the descending aorta and progresses proximally or distally | #Type III- Starts in the descending aorta and progresses proximally or distally | ||
##Type | ##Type III A - Restricted till the descending thoracic aorta | ||
##Type | ##Type III B - Dissection extending below the diaphragm | ||
*The third type of classification divides aortic dissection according to the proximity | *The third type of classification divides aortic dissection according to the proximity | ||
#Proximal- Ascending aortic involvement | #Proximal- Ascending aortic involvement | ||
#Distal- Descending aortic involvement distal to left subclavian artery | #Distal- Descending aortic involvement distal to left subclavian artery | ||
==Causes== | ==Causes== |
Revision as of 17:20, 7 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]
Definition
A tear in the layers of the aorta especially in the intima leading to bleeding and separation of the layers of the aorta from within which creates a false lumen. Aortic dissction can be further defined as:
- Acute dissection- Dissection occurring within 2 weeks of onset of pain
- Subacute dissection-Dissection occurring witin 2-6 weeks of onset of pain
- Chronic dissection- Dissection occurring within 6 weeks of pain.
Classification
Aortic dissection can be classified into four types. DeBakey and Daily (Stanford) systems are the commonly used systems used to classify aortic dissection.[1][2][3][4]
- Stanford system classifies dissection into the following two types based on whether ascending aorta is involved or not.
- Ascending aortic dissection or type A
- All other dissections or type B
- DeBakey system classifies dissection according to location of the tear.
- Type I- Starts at ascending aorta and extension upto the aortic arch
- Type II- Starts and is limited till the ascending aorta
- Type III- Starts in the descending aorta and progresses proximally or distally
- Type III A - Restricted till the descending thoracic aorta
- Type III B - Dissection extending below the diaphragm
- The third type of classification divides aortic dissection according to the proximity
- Proximal- Ascending aortic involvement
- Distal- Descending aortic involvement distal to left subclavian artery
Causes
Life Threatening Causes
Aortic dissection is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Atherosclerosis
- Complication of cardiac procedures
- Chest trauma
- Connective tissue disorders
- Hypertension
- Vasculitis[5]
Management
Do's
Dont's
References
- ↑ Nienaber, CA.; Eagle, KA. (2003). "Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies". Circulation. 108 (5): 628–35. doi:10.1161/01.CIR.0000087009.16755.E4. PMID 12900496. Unknown parameter
|month=
ignored (help) - ↑ Tsai, TT.; Nienaber, CA.; Eagle, KA. (2005). "Acute aortic syndromes". Circulation. 112 (24): 3802–13. doi:10.1161/CIRCULATIONAHA.105.534198. PMID 16344407. Unknown parameter
|month=
ignored (help) - ↑ DEBAKEY, ME.; HENLY, WS.; COOLEY, DA.; MORRIS, GC.; CRAWFORD, ES.; BEALL, AC. (1965). "SURGICAL MANAGEMENT OF DISSECTING ANEURYSMS OF THE AORTA". J Thorac Cardiovasc Surg. 49: 130–49. PMID 14261867. Unknown parameter
|month=
ignored (help) - ↑ Daily, PO.; Trueblood, HW.; Stinson, EB.; Wuerflein, RD.; Shumway, NE. (1970). "Management of acute aortic dissections". Ann Thorac Surg. 10 (3): 237–47. PMID 5458238. Unknown parameter
|month=
ignored (help) - ↑ "Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report number 11. Early Treatment Diabetic Retinopathy Study Research Group". Ophthalmology. 98 (5 Suppl): 807–22. 1991. PMID 2062514.