Aortic Dissection

• What are the RFs for aortic dissection?

  HTN

  Connective tissue disease

  Increased age

  Male

  Smoking

  Poor diet

  Obesity

  High cholesterol
• What is aortic dissection?

  Break/tear in aortic wall

  Between intima & media layers -> false lumen formation
• What is the classification of aortic dissection?

  Stanford

  • Type A -> affects ascending aorta, before brachiocephalic artery
  • Type B -> affects descending aorta, after left subclavian artery

  DeBakey

  • Type I -> begins in ascending aorta & involved at least aortic arch (if not whole aorta)
  • Type II -> isolated to ascending aorta
  • Type IIIa -> begins in descending aorta, involves only section above diaphragm
  • Type IIIb -> begins in descending aorta, involves aorta below diaphragm
• What are the signs & symptoms of aortic dissection?

  Severe tearing chest pain, radiates to back

  Unequal BP in arms (depend on where dissection is)

  Radio-radial delay

  Radio-femoral delay

  Hypotension (as dissection progresses)
• What are the Inx for aortic dissection?

  Obs

  Full Hx & examination

  ECG

  Bloods (FBC, U&Es, group & save, coag, VBG, LFTs)

  CT aorta (whole aorta)
• What is the management of aortic dissection?

  Bring BP down -> labetalol

  Analgesia

  Ring cardio/vascular reg

  Surgery

  • thoracic endovascular aortic repair (TEVAR) -> stent (Type B)
  • open surgery -> remove & replace affected part of aorta (Type A)
• What are the possible complications of aortic dissection?

  MI

  Stroke

  Paraplegia

  Cardiac tamponade

  Aortic regurgitation

  Death
• What is the definitive management of a Stanford type A vs type B aortic dissection?

  Type A = surgical repair

  Type B = BP reduction with IV labetalol