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Aortic dissection (categorization)


Aortic dissection, also called dissecting aneurysm of the aorta, is the tearing of the wall of the aorta, the large artery that exits the heart to circulate blood throughout the body. This is rare and very serious condition because it can lead to total rupture of the aorta and certain death. Very often, this dissection is localized in the thoracic aorta. However, there are several types of dissections, classified by type. Historically, we use the DeBakey anatomical classification, based on the origin of the tear and its extent. There are 3 types: type 1, which starts at the ascending aorta and goes down to the descending portion, type 2, which starts in and is located only on the ascending aorta, and type 3, which starts in and is localized on the descending aorta. More recently, the Stanford classification was introduced too with type A dissection, affecting the ascending aorta, and type B, affecting the descending aorta.


Symptoms of aortic dissection occur suddenly. Here are a few:
  • sudden chest pain or dorsal pain that feels like it's moving down the back;
  • migratory pain;
  • Other clinical signs are related to a complication of the dissection including the possible occurrence of an illness, shock, bleeding ...


Diagnosis and treatment are conducted simultaneously given the seriousness of the case. In addition to the observation of clinical signs, the doctor will perform a chest radiograph, electrocardiogram, and other imaging to locate the dissection such as a CT scan, an MRI or an ultrasound depending on the availability of these tests and the degree of emergency.


Treatments vary depending on the type of dissection. Dissections of the ascending aorta (Stanford type A) require immediate cardiac surgery. As for descending dissections (Stanford type B), treatment is initially done by catheterization with a stent and surgery is sometimes performed secondarily.


One must be vigilant by eating low salt foods and by regularly monitoring in the case of hypertension, which is the main risk factor for aortic dissection.

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