Tuesday, January 3, 2012

Aortic Dissection (AD)

Classic Aortic Dissection is the most common entity causing an acute aortic syndrome (70%).
  • Incidence: 1-10 : 100.000
  • mostly men
  • rarely < 60 year (etiology = media degeneration)
  • hypertension > 70%
  • Type A mortality 1-2% per hour after onset of symptoms, total up to 90% non-treated, 40% when treated.
  • 1 year survival Type B up to 85% if medically treated (5 year > 70%).
Classic Aortic Dissection

Management decisions are based on the following information:
  • Type A or Type B
  • Place of entry & re-entry
  • Side branches involved, originating form true / false lumen
  • Organs at risk (1/3 of mortality is caused by organ failure)
  • Complications (rupture, coronairy occlusion, aortic insufficiency, neurological )
  • Diameters of true and false lumina at: proximal and distal landing zones, at entry and at minimum
  • Iliac vessel tortuosity 
LEFT: Type A dissection with clear intimaflap seen within the aortic arch.
RIGHT: Type B dissection. Entry point distal to left subclavian artery.

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