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Aortic Dissection

Dr Swapnil Pawar August 25, 2021 489

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    Aortic Dissection
    Dr Swapnil Pawar

Aortic Dissection

Stanford Classification

Type A – Involves the ascending aorta, regardless of the origin of the primary tear

Type B – All other dissections that do not fit criteria as Type A

DeBakey’s Classification

Type 1 – Originates in the ascending aorta and propagates to at least the aortic arch

Type 2 – Originating in and confined to the ascending aorta

Type 3 – Originates in the descending aorta and extends distally or proximally (but not further than the left subclavian artery)

Predisposing conditions 

  • Hypertension
  • Atherosclerosis
  • Connective tissues disease (i.e. Marfan’s, Ehlers Danlos)
  • Bicuspid aortic valve
  • Previous aortic manipulation
  • Previous aortic aneurysm
  • Vasculitis

Complications of Aortic Dissection

  • Aortic regurgitation (involvement of the aortic root)
  • Pericardial effusion or tamponade (proximal tears)
  • Acute myocardial infarction (obstruction of aortic sinuses)
  • Stroke (involvement of the carotids) 
  • Acute kidney injury (involvement of renal arteries)
  • Visceral ischaemia (i.e. gut, spleen, liver, limbs, spine)
  • Aortic rupture or aneurysm

Management of Aortic Dissection

Anti-Impulse therapy – IV esmolol to aim BP <120/80. If HR drops below 60, consider vasodilator (i.e. sodium nitroprusside)

If the dissection involves the ascending aorta – will require immediate surgical referral for operative management

If no involvement of ascending aorta – managed with haemodynamic control (unless complicated – i.e.occlusion of an aortic branch resulting in ischaemia, persisting, uncontrolled pain, persistent hypertension despite medical therapy, aneurysm expansion or aortic rupture

X-Ray Features of Aortic Dissection

Widened mediastinum in context of aortic dissection


Bell, D.J., E., Gaillard, F. (2021). Aortic Dissection. Radiopaedia. Retrieved 14th August 2021 from

Black, J.H., Manning, W.J. (2021) Clinical Features and Diagnosis of Aortic Dissection. UpToDate. Retrieved 14th August 2021 from


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