Chapter 10: Aortic Dissection

The following sections are included:

• Aortic dissection may be defined according to the time since onset of symptoms as hyperacute (<24 h), acute (2–7 days), subacute (8–30 days) or chronic (>30 days).

• Acute aortic dissection is associated with hypertension and pre-existing disease of the aortic wall.

• Patients usually present with severe, tearing chest and back pain.

• Diagnosis is with transoesophageal echocardiogram and computed tomography (CT) angiogram.

• The Stanford or DeBakey classifications are used to describe the pattern of dissection.

• Type A dissections require early surgical treatment. The in-hospital mortality is high, but the prognosis is very good in patients surviving to discharge from hospital.

• Type B dissections are treated medically in the first instance. The in-hospital mortality is much lower compared to type A, but complications may occur following discharge.

• Chronic type B dissection may result in aortic dilatation and rupture, so surveillance is required.

• There is an expanding role for early endovascular intervention.