37 Aortic Dissection

Aortic Dissection

Pathogenesis

  • intima right next to blood

  • can spread distally to abdomen or proximally toward heart

  • type A mortality very high, surgery to correct, replace with graft
  • HTN drives blood into false lumen

Symptoms

  • stretch aortic valve: regurge

  • wraps around aorta

  • dissection obstructs blood flow to one arm
  • mediastinum: 1

Diagnosis

  • clots form after blood get into dissection

  • contrast CT
  • top: aorta
  • dissection flap: piece of tissue in middle. Blood broken through layers of aorta and separated aorta
  • True lumen: bigger one
  • false lumen: space inside flap
  • type A:

  • type B:

Risks

  • aortic dissection requires tension on wall and weakness of media layer
  • HTN leads to thick vasa vasorum
  • Marfans, Eherlos Danlos

  • aortopathy: abnormal aorta, in bicuspiad aortic valve and marfan

Complications

Aortic Aneurysms

  • true aneurysms

Thoracic

  • often identified by screening

Abdominal

  • almost always occur in association with atherosclerosis
  • above bifurcation, below renal arteries

Aortic Rupture

  • tear through all 3 layers
  • elasticity in proximal portion
  • rigid in descending portion