Aortic Dissection
Aortic dissection 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. It is more common in those with high blood pressure, connective tissue diseases like Marfan syndrome, a bicuspid aortic valve, and previous heart surgery. Symptoms include a sudden onset of severe chest or back pain. The diagnosis is suspected based on symptoms and confirmed with medical imaging. The Stanford classification divides dissections into type A, involving the ascending aorta, and type B, not involving it. Prevention involves controlling blood pressure and not smoking. Treatment may include surgery or medications to lower blood pressure and heart rate.
Aortic dissection is rare, with a mortality rate of 1% per hour initially. Prompt diagnosis and treatment are critical. The condition was first fully documented in an autopsy report of King George II of Great Britain in 1760. Surgery for aortic dissection was developed in the 1950s.
Signs and symptoms
About 96% of individuals with AD present with sudden severe pain. The pain may be described as tearing or sharp, in the chest, back, or abdomen. Less common symptoms include fainting, stroke, and heart failure.
Classification
| Percentage | 60% | 10–15% | 25–30% |
| Type | DeBakey I | DeBakey II | DeBakey III |
| Stanford A (proximal) | Stanford B (distal) | ||
The DeBakey and Stanford systems are used to describe aortic dissections. The Stanford classification divides dissections into type A and B, based on whether the ascending aorta is involved.
Prevention
Prevention includes blood pressure control and smoking cessation. Repair of an enlarged ascending aorta is recommended to decrease the risk of dissection.
Management
Stanford type A dissections generally require surgery, whereas type B dissections are usually treated with medication unless complications arise. Long-term follow-up involves strict blood pressure control.
Prognosis
The risk of death is highest in the first few hours and decreases afterward. With treatment, the survival rate for thoracic dissections may be as high as 90%.
Epidemiology
Aortic dissection affects about 3 per 100,000 people per year. It is more common in men and the mean age at diagnosis is 63.
History
The first fully documented case of aortic dissection was in 1760 in King George II of Great Britain. Surgery for AD was developed in the 1950s.