Endovascular management of acute thoracic aortic dissection and acute complication of chronic thoracic aortic dissection

Abstract

Aortic dissections result from a dynamic tear in the aortic wall allowing arterial blood flow to penetrate between the intima and media layers. This classically results in a false and true lumen and can form a plane antegrade, retrograde, or in combination. In the acute phase, the dissection flap appears friable, thin, and curvilinear on imaging. Chronicity can be determined with the flap appearing thick and straight. Dissections have been classified based on the location of the intimal tear by two separate systems. The DeBakey classification separates dissections into three types: Type 1 involves the ascending aorta as well as the descending portion. Type II involves only the ascending aorta. Type IIIa involves only the descending aorta. Type IIIb involves the descending and abdominal aorta and at times extends into the iliac system. The Stanford classification, more commonly utilized, has two types. Type A involves the ascending aorta and/or descending aorta. Type B involves only the descending aorta and spares the ascending and arch aorta.