Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. There are 2 major classification schemes of aortic dissection based on the location of the dissectionthe stanford classification and debakey classification. It can rob crucial blood from the rest of the body, it can cause the dissection to spread and. Aortic involvement was graded based on the dunning 3 criteria for classification of aortocoronary dissection. Abdominal aortic dissection can present with abdominal pain radiating to the flank or back. The goals of early management of aortic dissection are to control pain and limit the extension of the dissection using antiimpulse therapy, which typically involves administration of beta blockers and control of blood pressure. In those with an aad score web addenda document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult the task force for the diagnosis and treatment of aortic diseases of the european society of cardiology esc. A simple intervention to reduce your chance of missing an. Mar 26, 2015 aortic dissection an aortic dissection is a tearing of the layers within the aortic wall, classically associated with suddenonset chest or back pain, a pulse deficit, and mediastinal widening on a chest radiograph. Figure 7 indicates a stanford type b aortic dissection, arising distal to the left subclavian artery. For complicated type b aortic dissection, intramural haematoma and penetrating aortic ulcer surgery may be considered class iib c. Guidelines for the diagnosis and management of patients with.
Aortic dissection patients true stories aortic dissection. Chest, back or abdominal pain syncope symptoms consistent with perfusion deficit i. This most often occurs because of a tear or damage to the inner wall of the artery. Family history important predictor for aortic dissection. Although it is rare, doctors with an expertise in identifying. It can involve the ascending aorta, descending aorta, or both. Pdf acute aortic dissection is one of the most rapidly fatal clinical entities that can be encountered in the emergency department setting. The international registry of acute aortic dissection irad. A tear in the innermost layer of the aorta the intima allowing for blood to dissect between layers of the aortic wall, which may lead to endorgan damage or death. Take home points for aortic dissection diagnosis and management. In most cases, this is associated with a sudden onset of severe chest or back pain, often described as tearing in character. Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta the major artery from the heart.
The aortic extent and grading is illustrated in gray shading. Thoracic aortic aneurysms without dissection comprise a smaller subset of patients with aortic emergencies. Aortic dissection, axial views aortic dissection, sagittal views intramural hematoma type b lesions e f a,typeaaorticdissection,axial contrastenhancedcomputed tomographyctatthelevelofthe pulmonaryarterybifurcation starfalselumen. Percentage type i 1015% il 2530% debakey ill stanford b distal stanford a proximal tear intima onset of dissect ion ion of dissection progr esslon of d ssection. This is a pdf file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of.
Racgp aortic aneurysms screening, surveillance and. The finding of aortic dissection, aneurysm, traumatic injury andor aortic rupture should be immediately communicated to the referring physician. A new appraisal of the management of acute aortic dissection is timely because of recent developments in diagnostic strategies including biomarkers and imaging, endograft design, and surgical treatment, which have led to a better understanding of the epidemiology, risk factors, and molecular nature of aortic dissection. The human thoracic aorta, a complex geometric organ confounded by asymmetry and obliquity, consists of the ascending, arch, and descending aorta. Aortic emergencies ucsf emergency medicine ultrasound. Aortic dissection is considered acute if less than 14 days have elapsed since the dissection occurred. Acute medical management of acute aortic syndromes including aortic dissection involves controlling pain, and providing antiimpulse therapy in the form of blood pressure lowering and decreasing the velocity of left ventricular contraction, to decrease aortic shear stress and minimize the tendency for the dissection to propagate table 1. Look for marphans, listen for an aortic regurgitation murmur. Data were collected for 194 cases of acute aortic dissection with a mean age of 65sd 14. Setting the international registry of acute aortic dissection, consisting of 12 inter. Noncontrast computed tomography of type a acute aortic. Conversely, if the dissection is at least two weeks old, it is considered chronic. Analysis of acute type a aortic dissection in japan registry. Acute aortic dissection is a lifethreatening medical emergency associated with high rates of morbidity and mortality.
Focused bedside pretest risk assessment for acute aod. When an aortic dissection occurs in the first part of the aorta ascending aorta, up to 90% of patients can be saved with emergency surgery. An aortic dissection is a tear that occurs between the innermost and middle layers of the aorta. An aortic dissection is a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. For a deep dive into the worlds literature on ddimer for aortic dissection visit em cases journal jam 9. In addition, dissection can weaken the outer wall, resulting in instability or rupture.
Analysis of acute type a aortic dissection in japan registry of aortic dissection jrad running head. Depending on size and degree of aortic involvement, it may result in marked hemodynamic instability and, often, a rapid death. While the sensitivity of pocus by ed physicians to detect an intimal flap is only 67%, the specificity has been shown to be 99100%. The diagnosis and management of aortic dissection the bmj. An aortic dissection is a tear in the inner layer of the aortic wall. Aortic dissection cardiovascular disorders merck manuals. Jun 30, 2017 acute aortic syndromes are a constellation of lifethreatening medical conditions, including classic acute aortic dissection aad, intramural haematoma imh, penetrating atherosclerotic aortic ulcer pau even thoracic aortic rupture, which share common pathophysiological pathways breakdown of the intima and media, clinical. Prompt establishment of the diagnosis, through focused physical examination and noninvasive imaging, followed by rapid medical and surgical therapy. Pages in category deaths from aortic dissection the following 29 pages are in this category, out of 29 total. Given that acute type a aortic dissection typically mandates immediate repair, relatively little attention. The most common initial incorrect diagnosis were acute coronary syndrome 16, 47%, pulmonary embolism 5, 14. Although there were no findings suggestive of a rupture of the aorta, the true lumen from the ascending aorta to the descending thoracic aorta was pushed and completely collapsed because of the enlarged false lumen. Blood flow into the false lumen can cause several problems. Aortic dissection information mount sinai new york.
Aortic dissection is a rare and potentially fatal sequela of percutaneous coronary intervention pci. Tad is a dangerous condit ion, whereby tears along the ascending or descending aorta generate artificial channels false lumens of blood flow 1014. Sometimes, the term acute aortic syndrome is used to include classic aortic dissection, as well as intramural hematoma and penetrating aortic ulcer. Design case series with patients enrolled between january 1996 and december 1998. Dominos farms offers a number of relevant programs and. Dec 22, 2017 an aortic dissection is a medical emergency requiring immediate treatment. Rare but we should think about it most days because the inhospital mortality is 27% increasing by 1% per hour that we miss the diagnosis because it is very rare it means that it is hard to have a reliable decision rule or single clinical test that rules out the disease.
The dissection may occur anywhere along the aorta and extend proximally or distally into other arteries. Incidence 16100,000 for men, 9100,000 for women milewicz 2011 ratio of aortic dissection ad to acute coronary syndrome is 1. Racgp aortic aneurysms screening, surveillance and referral. Aortic dissection diagnosis and treatment mayo clinic. In case of type b penetrating aortic ulcer, surgery should be considered class iia c. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second bloodfilled channel within the wall. If the bloodfilled channel ruptures through the outside aortic wall, aortic dissection is often fatal. Aortic dissection identify patients at risk evaluation pathway aod ep. Aortic dissection is a condition of delamination of the aortic wall, leading to the development of a doublebarrel aorta, compromised luminal and side branch flow, and weakening of the aortic wall predisposing to aneurysmal degeneration. Therapy may include surgery or medications, depending on the area of the aorta involved. Aortic dissection michigan medicine university of michigan. Objective to assess the presentation, management, and outcomes of acute aortic dissection. Although it is rare, doctors with an expertise in identifying and treating this disease are critical to our field.
Residents can get free access to all of their resources and attending can get a discount on some of their great products at the eb medicine em basic page. Aortic dissection is the retinal detachment of the torso on pocus. Feb 01, 2016 aortic dissection is a rare and potentially fatal sequela of percutaneous coronary intervention pci. B,typebaortic dissection,axialcontrastenhanced ctatthelevelofthecarina starfalselumen. The exact prevalence of aortic dissection after pci is unknown, because occurrences might be unreported.
Aortic dissection an aortic dissection is a tearing of the layers within the aortic wall, classically associated with suddenonset chest or back pain, a pulse deficit, and mediastinal widening on a chest radiograph. Since the establishment of the international registry of acute aortic dissection irad in 2000 1, many informative articles have been published about aortic dissection. Aortic dissection show notes word format aortic dissection show notes pdf irad study link free full text irad study pdf free full text check out our bandwidth sponsor eb medicine. Assessment of wall shear stress in patients without aortic.
Although aortic dissection can affect anybody, it is most often seen in men 40 to 70 years old. Acute aortic dissection is one of the most rapidly fatal clinical entities that can be encountered in the emergency department setting. Aortic aneuryms when an aortic aneurysm is identified at any location, assessment of the entire aorta and aortic. Vital signs a patient experiencing aortic dissection may have normal vital signs, or have. Aortic dissection usually develops in the chest thoracic part of the aorta. The intimal tear may be a primary event or secondary to hemorrhage within the media. Analysis of acute type a aortic dissection in japan. Will only see changes if the dissection involves the coronary ostia. Aortic dissection is the surging of blood through a tear in the aortic intima with separation of the intima and media and creation of a false lumen channel. Timing of intervention differs for ascending type a and descending type b thoracic aortic dissection. An acute aortic dissection is the most common lifethreatening disorder of the aorta, affecting nearly 10,000 people per year in the united states. Aortic dissection is an exceptionally complex disease and remains one of the most misdiagnosed diseases across the globe. Anatomically, acute aortic dissection can be classi.
Aortic dissection ad how common is aortic dissection. Aortic dissection occurs with an annual incidence of 10 to 30 per million individuals. Consider acute aod in all patients presenting with. Also, vomiting, sweating, and lightheadedness may occur. Aortic dissection ad occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. The role of imaging in aortic dissection and related. Data are limited regarding the effect of recent imaging and therapeutic. Aortic dissection show notes pdf irad study link free full text irad study pdf free full text check out our bandwidth sponsor eb medicine. If aortic dissection is even remotely suspected, studies should be performed and read as soon as possible waiting could be the difference between life and death. Aortic dissection occurs when a tear occurs in the inner muscle wall lining of the aorta, allowing blood to split apart the muscle layers of the aortic wall symptoms of aortic dissection include a tearing or ripping pain in the chest, sweating, nausea, shortness of breath, weakness, or syncope. Aortic dissection is an exceptionally complex disease and remains one of the most misdi agnosed diseases across the globe. This tear allows blood to enter and separate the inner and outer layers of the vessel. Aortic dissection is caused by an intimal and medial tear in the aorta with propagation of a false lumen within the aortic media. Blood surges through the tear, causing the inner and middle layers of the aorta to separate dissect.
Aortic arch aortic dissection university of michigan. Untreated tad may lead to rupture of the vessels, and results in high mortality rates for the patients. Remember the big pain pearls when taking a history. Depending on the involvement of the ascending aorta, the stanford classification divides. Dissection of descending aorta dissection of ascending aorta heart aortic arch right left aortic dissection blood flow cross section of dissection true. The level of the most superior extent of the intimal flap is used to localize the highest level of retrograde aortic extension of the dissection. Aortic dissections occur in approximately 3 per 100,000 patients per year. Aortic dissection in young adults who abuse amphetamines. The ct showed aortic dissection extending from the root of the ascending aorta to the common iliac artery. Treatment for type a aortic dissection may include.