Aortic dissection
Description
- Intimal tear -> blood enters the media -> false lumen propagating antegrade or retrograde
- The most lethal aortic emergency: ~1-2% mortality per hour for the first 48 h in untreated type A
Classification
| Stanford | DeBakey | Involves | Treatment |
|---|---|---|---|
| A (~60%) | I (asc + arch + desc), II (asc only) | Ascending aorta | Emergency surgery |
| B (~40%) | III | Distal to left subclavian, ascending spared | Medical, unless complicated |
- Stanford is the one that matters: does it involve the ascending aorta? That single question drives everything
- Non-A non-B: arch involvement without ascending - managed case by case
Timing
- Acute <14 days, subacute 15-90 days, chronic >90 days
Acute aortic syndromes - the same clinical presentation
- Classic dissection
- Intramural haematoma (IMH) - no intimal flap; ~10-20%; may evolve into dissection or regress
- Penetrating atherosclerotic ulcer (PAU) - ulcerated plaque through the internal elastic lamina; elderly, atherosclerotic, often descending
- Contained rupture
6 more sections, plus exam facts
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