0071643192.pdf

The most common predisposing risk factor (see Table 2.19) for aortic dissection =
uncontrolled HTN.

PATHOPHYSIOLOGY

■ Disruption of intima of aortic wall →blood travels (dissects) into media,
creating false lumen.
■ Dissection can propagate down/up the aorta through the false lumen:
■ Proximally into aortic root →right coronary artery involvement, tam-
ponade, aortic regurgitation
■ Into carotid artery →stroke symptoms

CARDIOVASCULAR EMERGENCIES

Proximal dissection Distal dissection Proximal & distal

dissection

DeBakey II

Stanford A

DeBakey III

Stanford B

DeBakey I

Stanford A

DeBakey

IIIa

DeBakey

IIIb

FIGURE 2.17. DeBakey and Stanford classifications of aortic dissection.

(Reproduced, with permission, from Brunicardi FC. Schwartz’s Principles of Surgery, 8th ed,
New York: McGraw-Hill 2005:704.)

TABLE 2.19. Risk Factors for Aortic Dissection

Uncontrolled hypertension

Advancing age

Connective tissue disease

(eg, Marfan syndrome)

Congenital heart disease

(eg, bicuspid aortic valve)

Giant cell arteritis

Annuloaortic ectasia

Family history

Stimulant abuse

Iatrogenic

(catheterization or surgery)