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Difference between revisions of "Aortic dissection"
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'''Aortic dissection''', abbreviated '''AoD''', is an uncommon condition with a relatively high mortality. | |||
==General== | |||
Risk factors: | |||
*[[Hypertension]].<ref name=pmid21968475>{{Cite journal | last1 = Braverman | first1 = AC. | title = Aortic dissection: prompt diagnosis and emergency treatment are critical. | journal = Cleve Clin J Med | volume = 78 | issue = 10 | pages = 685-96 | month = Oct | year = 2011 | doi = 10.3949/ccjm.78a.11053 | PMID = 21968475 | URL = http://www.ccjm.org/content/78/10/685.long }}</ref> | |||
*[[Atherosclerosis]].<ref name=pmid21173794>{{Cite journal | last1 = LeMaire | first1 = SA. | last2 = Russell | first2 = L. | title = Epidemiology of thoracic aortic dissection. | journal = Nat Rev Cardiol | volume = 8 | issue = 2 | pages = 103-13 | month = Feb | year = 2011 | doi = 10.1038/nrcardio.2010.187 | PMID = 21173794 }}</ref> | |||
**[[Smoking]]. | |||
*Cardiac surgery - rare, well-known complication.<ref name=pmid22345184>{{Cite journal | last1 = Leontyev | first1 = S. | last2 = Borger | first2 = MA. | last3 = Legare | first3 = JF. | last4 = Merk | first4 = D. | last5 = Hahn | first5 = J. | last6 = Seeburger | first6 = J. | last7 = Lehmann | first7 = S. | last8 = Mohr | first8 = FW. | title = Iatrogenic type A aortic dissection during cardiac procedures: early and late outcome in 48 patients. | journal = Eur J Cardiothorac Surg | volume = 41 | issue = 3 | pages = 641-6 | month = Mar | year = 2012 | doi = 10.1093/ejcts/ezr070 | PMID = 22345184 }}</ref> | |||
**In one large registry, approximately 15% of acute dissections are associated with prior cardiac surgery.<ref name=pmid24030404>{{cite journal |author=Teman NR, Peterson MD, Russo MJ, ''et al.'' |title=Outcomes of patients presenting with acute type A aortic dissection in the setting of prior cardiac surgery: an analysis from the International Registry of Acute Aortic Dissection |journal=Circulation |volume=128 |issue=11 Suppl 1 |pages=S180–5 |year=2013 |month=September |pmid=24030404 |doi=10.1161/CIRCULATIONAHA.112.000342 |url=}}</ref> | |||
Note: | |||
*Diabetes uncommon in thoracic aortic dissection.<ref name=pmid21173794/> | |||
May be separated into two groups:<ref>URL: [http://path.upmc.edu/cases/case84/dx.html http://path.upmc.edu/cases/case84/dx.html]. Accessed on: 13 May 2014.</ref> | |||
#Hypertension + atherosclerosis, typically 40-60 years old. | |||
#Connective tissue disorders - "young". | |||
===Associations=== | |||
Heritable:<ref name=pmid16253833>{{cite journal |author=Gleason TG |title=Heritable disorders predisposing to aortic dissection |journal=Semin. Thorac. Cardiovasc. Surg. |volume=17 |issue=3 |pages=274-81 |year=2005 |pmid=16253833 |doi=10.1053/j.semtcvs.2005.06.001 |url=}}</ref> | |||
*[[Marfan's syndrome]]. | |||
*Loeys-Dietz syndrome - a Marfan-like syndrome<ref name=pmid16928994>{{cite journal |author=Loeys BL, Schwarze U, Holm T, ''et al'' |title=Aneurysm syndromes caused by mutations in the TGF-beta receptor |journal=N. Engl. J. Med. |volume=355 |issue=8 |pages=788-98 |year=2006 |month=August |pmid=16928994 |doi=10.1056/NEJMoa055695 |url=http://content.nejm.org/cgi/content/full/355/8/788}}</ref> | |||
*[[Ehlers-Danlos syndrome]]. | |||
*[[Bicuspid aortic valve]].<ref name=pmid21173794/> | |||
Others: | |||
*Tertiary [[syphilis]].<ref name=pmid20864080>{{Cite journal | last1 = Cruz | first1 = RP. | last2 = Marrone | first2 = LC. | last3 = Marrone | first3 = AC. | title = Chronic syphilitic aortic aneurysm complicated with chronic aortic dissection. | journal = Am J Surg | volume = 200 | issue = 5 | pages = e64-6 | month = Nov | year = 2010 | doi = 10.1016/j.amjsurg.2010.02.017 | PMID = 20864080 }}</ref> | |||
*[[Turner syndrome]].<ref name=pmid21731587>{{Cite journal | last1 = Carlson | first1 = M. | last2 = Silberbach | first2 = M. | title = Dissection of the aorta in Turner syndrome: two cases and review of 85 cases in the literature. | journal = BMJ Case Rep | volume = 2009 | issue = | pages = bcr0620091998 | month = | year = 2009 | doi = 10.1136/bcr.06.2009.1998 | PMID = 21731587 }}</ref> | |||
===Classification=== | |||
Two classification exist: | |||
*''DeBakey''. | |||
*''Stanford''. | |||
Stanford dissection classification:<ref name=pmid9362838>{{cite journal |author=Finkelmeier BA |title=Dissection of the aorta: a clinical update |journal=J Vasc Nurs |volume=15 |issue=3 |pages=88-93 |year=1997 |month=September |pmid=9362838 |doi= |url=}}</ref> | |||
*Type A - aortic root to the left subclavian artery. | |||
**Considered a surgical emergency. | |||
*Type B - distal to (left) subclavian artery. | |||
**Generally, treated conservatively. | |||
==Gross== | |||
*Entry intimal tear +/- exit intimal tear. | |||
**Blood between layers of the vessel wall. | |||
===Images=== | |||
<gallery> | |||
Image:AoDiss_Patho.jpg | Aortic dissection. (WC) | |||
</gallery> | |||
www: | |||
*[http://library.med.utah.edu/WebPath/CVHTML/CV031.html Aortic dissection (utah.edu)]. | |||
*[http://www.brown.edu/Courses/Digital_Path/systemic_path/cardio/ad-gross.html Aortic dissection (brown.edu)]. | |||
==Microscopic== | |||
Features: | |||
*Defect in the tunica media (muscle layer). | |||
*"Abundant" fresh blood in the adventitia. | |||
*+/-Changes of [[cystic medial degeneration]] - a specific histopathologic cause of aortic dissection. | |||
DDx: | |||
*[[Cystic medial degeneration]]. | |||
===Images=== | |||
<gallery> | |||
Image:Aortic dissection (1) Victoria blue-HE.jpg | Aortic dissection. Victoria blue-H&E. (WC/KGH) | |||
</gallery> | |||
www: | |||
*[http://path.upmc.edu/cases/case84.html Aortic dissection - autopsy (upmc.edu)]. | |||
*[http://library.med.utah.edu/WebPath/CVHTML/CV029.html Aortic dissection (utah.edu)]. | |||
==See also== | |||
*[[Vascular disease]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Vascular disease]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||