Aortic Dissection

Aortic dissection
 Commonest aortic emergency
 Incidence is twice that of ruptured abdominal
aortic aneurysm
 Rare less than 40 years of age
 Most commonly seen between 50 and 70 year
s
 Male:female ratio is equal
 Associated with hypertension, Marfan’s syndr
one, bicuspid aortic valve
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Types of Aortic Syndromes
Classification of Variants of Aortic Dissection

Class Description
1 Separation of intima/media; dual lumens (classic)
2 Intramural hematoma separation of intima/media; no int
raluminal tear or flap imaged
3 Intimal tear without hematoma (limited dissection) and
eccentric bulge
4 Atherosclerotic penetrating ulcer; ulcer usually penetrat
ing to adventitia with localized hematoma
5 Iatrogenic/traumatic dissection
Circulation. 1999;99:1331-1336
 Therapeutic management
 Medical treatment
 Surgical treatment
 Surgery in type A dissection
 Surgery in type B dissection
 Interventional therapy
 Fenestration
 Stent-Graft placement
 Interventional Therapy in Aortic
Dissection
 Interventional therapy in aortic dissection provides ne
w approaches to handle complications.
 Aortic fenestration with or without stent placement all
ows immediate relief of organ malperfusion for:
 Visceral / Renal/ Limb ischaemia either before or after sur
gical treatment
 Graft stent implantation is an evolving technique whi
ch opens new avenues to treat type B (type III) dissect
ion. Occlusion of entry tears induces thrombus format
ion and vessel wall healing.
Stent-Graft in Aortic Dissection
Percutaneous Separate Stent-Graft

Radiology 2001; 220:533-539