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Clinical features and diagnosis of acute aortic dissection

Authors
Warren J Manning, MD
James H Black, III, MD
Section Editors
Emile R Mohler III, MD
James Hoekstra, MD
Joseph L Mills, Sr, MD
John F Eidt, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Aortic dissection is relatively uncommon, but it often presents acutely as a catastrophic illness with severe chest pain and acute hemodynamic compromise. Early and accurate diagnosis and treatment are crucial for survival.

Death from aortic dissection can be related to rupture of the dissection into the pericardium precipitating cardiac tamponade, acute dissection into the aortic valvular annulus leading to severe aortic regurgitation, obstruction of the coronary artery ostia leading to myocardial infarction, and end-organ failure due to abdominal aortic branch vessel obstruction [1,2]. The International Registry of Acute Aortic Dissection (IRAD) has provided a contemporary perspective from the worldwide accrual of patients into a prospective database and allowed assessment of treatment paradigms. Despite the advances detailed in their reports, the mortality of aortic dissection remains at 25 to 30 percent [3].

The clinical manifestations and diagnosis of acute aortic dissection will be reviewed here. Medical and surgical management are discussed separately. (See "Management of acute aortic dissection" and "Surgical and endovascular management of type B aortic dissection".)

CLASSIFICATION

Aortic dissection is classified, somewhat arbitrarily, as acute or chronic based upon the duration of symptoms at the time of presentation. During the first two weeks (acute phase), life-threatening complications due to branch involvement or aortic rupture are more likely to occur compared with the timeframe past two weeks (chronic phase) [4,5].

Anatomic classification — The two main anatomic classifications used to classify aortic dissection are the DeBakey and Daily (Stanford) systems (figure 1) [6-9]. The Stanford system is more widely used. It classifies dissections that involve the ascending aorta as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. By comparison, the DeBakey system is based upon the site of origin, with type 1 originating in the ascending aorta and propagating to at least the aortic arch, type 2 originating in and confined to the ascending aorta, and type 3 originating in the descending aorta and extending distally or proximally. An alternative classification has been proposed, the DISSECT classification system, which assesses six characteristics of dissection that communicate the most salient details influencing the choice of treatment, particularly those that are important when considering an endovascular procedure [10].

                          

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Literature review current through: Nov 2016. | This topic last updated: Wed Sep 14 00:00:00 GMT+00:00 2016.
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