Thoracic aortic dissection

Overview flow through the aortic intima Broken split into the aorta, the aortic wall hematoma formation. Expanding hematoma, the aortic wall will be removed within the middle and outer layers, known as aortic dissection. Sennertus 1542, 1761 Morgagni of the disease is described. Laennec in 1826 called dissection. Aortic dissection of morbidity, per million population is about 5 ~ 10 cases. The sex ratio is about 3 : 1, age of onset of the majority over the age of 40. Cause pathogenesis middle aortic wall degeneration, the different organizations adhesion strength diminishes, aortic wall by the impact of blood vessels nourish or broken crack pipe rupture caused endometrial, middle aorta dissection. to create the thin, slice thickness within the intramural hematoma. Heart beat stress on the ascending aorta and the proximal descending aorta greatest impact, thus 60 ~ 70% of cases dissection in the ascending aorta of origin, 25% of recent origin in descending aorta. About 90% of cases and hypertension. Dissection, to extend the term of the aorta, the aortic involvement length and the abdominal aorta and its branches; Near to the extension of the aorta were involved coronary artery and aortic valve, resulting in the highest blood flow occlusion or aortic insufficiency. SANDWICH lesions involving the carotid artery were symptoms of cerebral ischemia; Intercostal artery involvement can lead to spinal cord ischemia paraplegia; Renal artery involvement resulted in renal failure; iliac and femoral arteries involved may lead to limb necrosis. Dissection grow up as the outer layer to break into the pleural or pericardial cavity resonator, created pericardial tamponade or massive hemothorax cause death. Some patients aneurysm inner cavity to break into the aorta, the aortic flow channel formed two. Aortic dissection is no longer on the process of development and the illness have been alleviated. Type : 1965 DeBakey dissection by the location and area into three types (Figure 4), Clinical be widely applied. Figure 4 dissection classification DeBakey type I : intimal rupture in the ascending aorta. Aortic dissection scope originated in the ascending aorta and aortic arch involvement, the descending aorta and may extend to the abdominal aorta. Type II : intimal rupture in the ascending aorta and aortic dissection wall confined ascending aorta. Type III : intimal rupture in the left subclavian artery distal to the recent opening of the descending aorta. Aortic direction to the descending aorta dissection can be extended to the abdominal aorta, but not involving the ascending aorta wall. Stanford type under the ascending aorta whether involvement divided into A and B two types (Figure 5). Figure 5 dissection Stanford type A classification : endometriosis may rupture at the ascending aorta. aortic arch or proximal descending aorta. Dissection of the ascending aorta involved, or the aortic arch and descending aorta and abdominal aorta. Stanforda-equivalent to the DeBakey type I and type II-type. A number of cases of about 66%. B : intimal rupture of the Standing near the descending aorta. dissection is limited to the scope of the descending aorta or aortic Rufu extension, but without implicating the ascending aorta. DeBakey type III equivalent. B type accounts for about 33%.