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==Classification==
==Classification==
*Several classification systems have been suggested for the description of aortic dissection.<ref name="pmid12900496">{{cite journal |vauthors=Nienaber CA, Eagle 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 |date=August 2003 |pmid=12900496 |doi=10.1161/01.CIR.0000087009.16755.E4 |url=}}</ref><ref name="pmid16344407">{{cite journal |vauthors=Tsai TT, Nienaber CA, Eagle KA |title=Acute aortic syndromes |journal=Circulation |volume=112 |issue=24 |pages=3802–13 |date=December 2005 |pmid=16344407 |doi=10.1161/CIRCULATIONAHA.105.534198 |url=}}</ref><ref name="pmid14261867">{{cite journal |vauthors=DEBAKEY ME, HENLY WS, COOLEY DA, MORRIS GC, CRAWFORD ES, BEALL AC |title=SURGICAL MANAGEMENT OF DISSECTING ANEURYSMS OF THE AORTA |journal=J. Thorac. Cardiovasc. Surg. |volume=49 |issue= |pages=130–49 |date=January 1965 |pmid=14261867 |doi= |url=}}</ref><ref name="pmid5458238">{{cite journal |vauthors=Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE |title=Management of acute aortic dissections |journal=Ann. Thorac. Surg. |volume=10 |issue=3 |pages=237–47 |date=September 1970 |pmid=5458238 |doi=10.1016/s0003-4975(10)65594-4 |url=}}</ref>
*Several [[classification]] systems have been suggested for the description of aortic dissection.<ref name="pmid12900496">{{cite journal |vauthors=Nienaber CA, Eagle 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 |date=August 2003 |pmid=12900496 |doi=10.1161/01.CIR.0000087009.16755.E4 |url=}}</ref><ref name="pmid16344407">{{cite journal |vauthors=Tsai TT, Nienaber CA, Eagle KA |title=Acute aortic syndromes |journal=Circulation |volume=112 |issue=24 |pages=3802–13 |date=December 2005 |pmid=16344407 |doi=10.1161/CIRCULATIONAHA.105.534198 |url=}}</ref><ref name="pmid14261867">{{cite journal |vauthors=DEBAKEY ME, HENLY WS, COOLEY DA, MORRIS GC, CRAWFORD ES, BEALL AC |title=SURGICAL MANAGEMENT OF DISSECTING ANEURYSMS OF THE AORTA |journal=J. Thorac. Cardiovasc. Surg. |volume=49 |issue= |pages=130–49 |date=January 1965 |pmid=14261867 |doi= |url=}}</ref><ref name="pmid5458238">{{cite journal |vauthors=Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE |title=Management of acute aortic dissections |journal=Ann. Thorac. Surg. |volume=10 |issue=3 |pages=237–47 |date=September 1970 |pmid=5458238 |doi=10.1016/s0003-4975(10)65594-4 |url=}}</ref>
*The commonly used classifications for aortic dissection are either based on the timing of the symptoms or the anatomy of the dissection.  
*The commonly used [[classifications]] for aortic dissection are either based on the timing of the symptoms or the [[anatomy]] of the dissection.
*DeBakey and Stanford systems are the commonly used classification systems for aortic dissection.
*DeBakey and Stanford systems are the commonly used [[classification]] systems for aortic dissection.
===DeBakey Classification System===
===DeBakey Classification System===
The DeBakey system is an [[anatomy|anatomical]] description of the [[aortic]] dissection. It categorizes the dissection based on where the original [[intima]]l tear is located and the extent of the dissection (localized to either the [[ascending aorta]] or [[descending aorta]], or involves both the [[ascending aorta|ascending]] and [[descending aorta]].<ref>DeBakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr. Surgical management of dissecting aneurysms of the aorta. ''J Thorac Cardiovasc Surg'' 1965;49:130-49. PMID 14261867.</ref>
The DeBakey system classifies aortic dissection based on [[anatomy]] of the aorta. It classifies the [[dissection]] according to the [[intimal]] tear location.<ref>DeBakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr. Surgical management of dissecting aneurysms of the aorta. ''J Thorac Cardiovasc Surg'' 1965;49:130-49. PMID 14261867.</ref>
*''Type I'' - Originates in [[ascending aorta]], propagates at least to the [[aortic arch]] and often beyond it [[distal]]ly.
*''Type I'' - [[Intimal]] tear is located in [[ascending aorta]], spreads at least to the [[aortic arch]] and often beyond it [[distal]]ly.
*''Type II'' – Originates in and is confined to the [[ascending aorta]].
*''Type II'' –[[Intimal]] tear is located and limited to the [[ascending aorta]].
*''Type III'' – Originates in [[descending aorta]], rarely extends [[proximal]]ly.
*''Type III'' – [[Intimal]] tear is located in [[descending aorta]], rarely extends [[proximal]]ly.
:*'''Type III A''': Restricted till the descending [[thoracic aorta]]
 
:*'''Type III B''': Dissection extending below the [[diaphragm]]
:*'''Type III A''': Dissection limited to the descending [[thoracic aorta]]
:*'''Type III B''': Dissection extended below the [[diaphragm]]


[[Chronic]] dissection is almost twice as common in patients with type III (45%) when compared with type I (24%) and type II dissection (27%).
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===Stanford Classification System===
===Stanford Classification System===
Divided into 2 groups; A and B depending on whether the ascending [[aorta]] is involved.<ref>Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. ''Ann Thorac Surg'' 1970;10:237-47. PMID 5458238.</ref>
Stanford classification system is based on the involvement of [[ascending aorta]].<ref>Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. ''Ann Thorac Surg'' 1970;10:237-47. PMID 5458238.</ref>
 
*''A'' = ''Type I'' and ''II'' DeBakey
*''A'' = ''Type I'' and ''II'' DeBakey
*''B'' = ''Type III'' Debakey
*''B'' = ''Type III'' Debakey

Revision as of 18:28, 25 November 2019

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Case #1


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Several different classification systems have been used to describe aortic dissections. The systems commonly in use are either based on either the anatomy of the dissection (proximal, distal) or the duration of onset of symptoms (acute, chronic) prior to presentation.

Classification

  • Several classification systems have been suggested for the description of aortic dissection.[1][2][3][4]
  • The commonly used classifications for aortic dissection are either based on the timing of the symptoms or the anatomy of the dissection.
  • DeBakey and Stanford systems are the commonly used classification systems for aortic dissection.

DeBakey Classification System

The DeBakey system classifies aortic dissection based on anatomy of the aorta. It classifies the dissection according to the intimal tear location.[5]

  • Type III A: Dissection limited to the descending thoracic aorta
  • Type III B: Dissection extended below the diaphragm
Percentage 60 % 10-15 % 25-30 %
Type DeBakey I DeBakey II DeBakey III
Stanford A Stanford B
  Proximal Distal
Classification of aortic dissection

Stanford Classification System

Stanford classification system is based on the involvement of ascending aorta.[6]

  • A = Type I and II DeBakey
  • B = Type III Debakey
Dissection of the aorta descendens (3), which starts from the left subclavian artery, reaching to the abdominal aorta (4). Aorta ascendens (1) and aortic arch (2) are not involved.


Classification based on the Proximity

  1. Proximal: Ascending aortic involvement
  2. Distal: Descending aortic involvement distal to left subclavian artery

Classification by the Time of Onset

  1. Acute: Onset within 2 weeks of onset of pain
  2. Subacute: Onset within 2-6 weeks of onset of pain
  3. Chronic: Onset within 6 weeks of pain.

References

  1. ↑ Nienaber CA, Eagle KA (August 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.
  2. ↑ Tsai TT, Nienaber CA, Eagle KA (December 2005). "Acute aortic syndromes". Circulation. 112 (24): 3802–13. doi:10.1161/CIRCULATIONAHA.105.534198. PMID 16344407.
  3. ↑ DEBAKEY ME, HENLY WS, COOLEY DA, MORRIS GC, CRAWFORD ES, BEALL AC (January 1965). "SURGICAL MANAGEMENT OF DISSECTING ANEURYSMS OF THE AORTA". J. Thorac. Cardiovasc. Surg. 49: 130–49. PMID 14261867.
  4. ↑ Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE (September 1970). "Management of acute aortic dissections". Ann. Thorac. Surg. 10 (3): 237–47. doi:10.1016/s0003-4975(10)65594-4. PMID 5458238.
  5. ↑ DeBakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg 1965;49:130-49. PMID 14261867.
  6. ↑ Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg 1970;10:237-47. PMID 5458238.

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