(Surgery)

Overview

• Tear in the aortic wall intima, causing blood to flow into a new false lumen in the intima-media space → this can cause a haematoma to form and rupture, causing occlusion of vessels
• 60-80 yrs old (30-50 yrs in patients with Marfan Syndrome → connective tissue disorders predispose to both aneurysms & dissections)
• Most commonly occurs in Ascending Aorta
• Stanford Classification
  • Stanford Type A (2/3 of cases) ****→ any dissection involving the ascending aorta
  • Stanford Type B (1/3 of cases) ****→ any dissection involving the descending aorta only (distal to left subclavian artery)
• DeBakey Classification
  • Type I → dissection involves ascending and descending aorta
  • Type II → dissection involves only ascending aorta (up to the brachiocephalic artery)
  • Type III → involves only descending aorta (distal to left subclavian artery)
• Risk Factors → Hypertension (most important RF), Trauma, Marfan Syndrome (tall + high-arched palate, Autosomal Dominant), Ehlers-Danlos Syndrome, Bicuspid Aortic Valve, Smoking

Making Diagnosis

Clinical Features:

• Sudden & Severe tearing chest pain
• Interscapular (radiates to back) pain
• Asymmetrical BP & Pulse between limbs (mainly arms)
  • May also have weak or absent carotid, brachial, or femoral pulse.
  • Radio-radial delay and radio-femoral delay
• Early Diastolic Murmur (Aortic Regurgitation)
  • Austin Flint Murmur ⇒ mid-diastolic murmur best heard at the apex. Sign of severe aortic regurgitation.
• Focal Neurological Deficits (eg. Horner’s Syndrome in carotid dissection)
• Hypertension