Aortic dissection classification

Aortic dissection Microchapters
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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.

Anatomic Classification

DeBakey classification system

The DeBakey system is an anatomical description of the aortic dissection. It categorizes the dissection based on where the original intimal tear is located and the extent of the dissection (localized to either the ascending aorta or descending aorta, or involves both the ascending and descending aorta.

• Type I - Originates in ascending aorta, propagates at least to the aortic arch and often beyond it distally.
• Type II – Originates in and is confined to the ascending aorta.
• Type III – Originates in descending aorta, rarely extends proximally.

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

Divided into 2 groups; A and B depending on whether the ascending aorta is involved.

• 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 Chronicity

• Chronic dissection is almost twice as common in patients with type III (45%) when compared with type I (24%) and type II dissection (27%).