Aortic dissection

Question 1

Is AAA or aortic dissection more common?

Answer 1

aortic dissection 3x more common

Question 2

What are the risk factors for aortic dissection

Answer 2

HTN, cocaine, bicuspid aortic valve, smoking, cardiac surgery, connective tissue disorders

Question 3

What happens in aortic dissection?

Answer 3

intima tears and blood fills layers between it and media

Question 4

How is dissection diagnosed?

Answer 4

CT angiogram

Question 5

How is Stanford classification divided?

Answer 5

Type A: dissection involves the ascending aorta with or without involvement of the arch and descending aorta. Accounts for 60-70% of cases.
Type B (TBAD): Involves only the descending aorta (distal to the left subclavian artery) and/or abdominal aorta. Accounts for 30-40% of cases

Question 6

Describe three complications of aortic dissection

Answer 6

aortic rupture
MI

cardiac tamponade
acute aortic regurg
Renal failure
Bowel ischaemia
Acute limb ischaemia

Question 7

List two signs of dissection on CT

Answer 7

1. Double lumen (true and false lumens) thus confirming the diagnosis of AAD
2. The entry tear (where the dissection begins)
3. Any evidence of aortic dilatation (aneurysmal change)
4. Evidence of end-organ malperfusion (for example non-enhancing kidney)
5. Features of acute rupture (including extravasation of contrast or haemothorax)

Question 8

What are the indications for surgery in aortic dissection?

Answer 8

Type A or retrograde type B
Persistent pain
Aortic rupture
Extension despite optimal medical management