These individuals have been self-selected as survivors of the acute episode and can be treated with medical therapy as long as they are stable. Mayo Clin Proc. Image courtesy of Kaiser-Permanente.

This contrasts with peripheral arteries, which, in comparison, have more smooth muscle and collagen between the elastic layers. Multidetector CT of Aortic Dissection: A Pictorial Review.

The Stanford system is used more commonly now, as it is more attuned to the management of the patient.

J Thorac Cardiovasc Surg. Aortic dissection may be a late sequela of heart surgery.

Le stenting est très utilisé en cas de malperfusion statique. Circulation Journal.

Les endoprothèses aortiques ont été d’un apport considérable dans la prise en charge de cette situation.

[6] Anterior chest pain is associated with dissections involving the ascending aorta, while interscapular back pain is associated with descending aortic dissections.

From 1% to 2% of patients with aortic dissection die per hour for the first 24-48 hours.

Most cases occur in the third trimester or early postpartum period.

Aortic dissection is defined as separation of the layers within the aortic wall. Long-term blood pressure control is required for every person who has experienced aortic dissection. This includes inherited conditions in which your body tissues develop abnormally, such as Marfan’s syndrome, atherosclerosis, and accidental injuries to the chest. It tends to be higher in individuals with a distal dissection.

Management of Intramural Hematomas and Penetrating Ulcers, https://acsearch.acr.org/docs/69402/Narrative/, http://www.nytimes.com/2006/12/25/health/25surgeon.html?pagewanted=1&ei=5094&en=e9f039dd9b8b2d74&hp&ex=1167109200&partner=homepage, https://www.fda.gov/Drugs/DrugSafety/ucm628753.htm, American Association for Thoracic Surgery, Society for Surgery of the Alimentary Tract, American College of Physicians-American Society of Internal Medicine, American Society for Artificial Internal Organs. Is Pericardiocentesis Harmful?

Image Predictors of Treatment Outcome after Thoracic Aortic Dissection Repair.

Researchers have used the term cystic medial degeneration. An aortic dissection secondary to an intramural hematoma should be treated the same as one caused by an intimal tear.

The left and right coronary arteries arise from these sinuses.

The upper tubular segment of the ascending aorta starts at the sinotubular junction and ends at the beginning of the aortic arch.

[Medline]. Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. [3], About 96% of individuals with AD present with severe pain that had a sudden onset.

The nervi vascularis, bundles of nerve fibers found in the aortic adventitia, are involved in the production of pain, which occurs with acute stretching of the aortic wall from a dissection.

Complications of all types of aortic dissection include: A Stanford type A dissection may also result in: Although the combination of blood pressure control and surgical intervention has significantly lowered in-hospital mortality, it remains significant, at 10-35%. Mayo Clinic is a not-for-profit organization. Image D is classified in a manner similar to A but contains an additional entry tear in the descending thoracic aorta. [citation needed] Complicated Stanford type B aortic dissections require surgical intervention after initiation of medical therapy. JAMA. Note that a primary arch dissection does not fit neatly into either classification. J Thromb Thrombolysis. (2004) The Annals of thoracic surgery. This website also contains material copyrighted by 3rd parties.

2009 Feb. 73 (2):264-8. The aortic media contains very little smooth muscle and collagen between the elastic layers and thus has increased distensibility, elasticity, and tensile strength.

For Stanford type A (ascending aortic) dissection, surgical management is superior to medical management. In addition, a 17% to 25% incidence exists of new aneurysm formation, typically due to dilatation of the residual false lumen.

[2][3] Major trauma, smoking, cocaine use, pregnancy, a thoracic aortic aneurysm, inflammation of arteries, and abnormal lipid levels are also associated with an increased risk. About 18% of individuals who present with an acute aortic dissection have a history of open-heart surgery. Am Heart J.

The normal lumen lined by intima is called the true lumen and the blood-filled channel in the media is called the false lumen. In general, the imaging technique chosen is based on the pretest likelihood of the diagnosis, availability of the testing modality, patient stability, and the sensitivity and specificity of the test. Make a donation.

Sources disagree over the accuracy of this term in elderly patients because the true histopathologic changes are neither cystic nor necrotic.

While it is not always clear why an intimal tear may occur, quite often it involves degeneration of the collagen and elastin that make up the media. J Am Coll Cardiol. [3] In most cases, this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. Flap at lower right of image. Between 5% and 10% of dissections do not have an obvious intimal tear. Mary C Mancini, MD, PhD, MMM is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic SurgeonsDisclosure: Nothing to disclose.

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