Aortic Dissection

Acute vs. chronic aortic dissection

  • Acute dissection: Symptoms or dissection occurring within the last 14 days
  • Chronic dissection: Symptoms or dissection occurring after the 14th day

Complicated vs. un-complicated aortic dissection

Complicated aortic dissection is the term used for patients who present with, or during the hospital course, develop the following: rupture, malperfusion syndromes (poor blood supply to the intestine, kidneys, or legs), refractory pain or rapid aortic expansion. Patients with complicated aortic dissection usually require endovascular or open surgical intervention.

The DeBakey classification of aortic dissection

The DeBakey classification of aortic dissection:

  • Type I refers to dissections that propagate from the ascending aorta, extend to the aortic arch, and commonly, beyond the arch distally.
  • Type II refers to dissections that are confined to the ascending portion of the aorta.
  • Type III dissections are limited to the descending aorta. Class III also includes the dissections that start in the descending aorta that extend proximally to the arch and ascending aorta.

 

The Stanford classification of aortic dissection:

The Stanford classification of aortic dissection:

  • Stanford type A includes aortic dissections that involve the ascending aorta (with or without involvement of the transverse and descending thoracic aorta).
  • Stanford type B includes aortic dissections that originate in the descending (and thoracoabdominal) aorta, regardless of any retrograde involvement of the arch.

 

Descending aortic dissections

Descending aortic dissections (Stanford type B or DeBakey type III) are divided in four types for endovascular purposes:

  • Type 1 has no identifiable intimomedial tears in the descending thoracic aorta.
  • Type 2 has one or more intimomedial tears in the descending thoracic aorta and there is no tear at or distal to the level of the celiac artery.
  • Type 3 has intimomedial tears involving the abdominal aorta (with or without concomitant tears in the descending thoracic aorta).
  • Type 4 has intimomedial tears distal to the aortic bifurcation (with or without concomitant tears in the descending thoracic and abdominal aorta).