Clinical Profiles Of Type A And Type B Dissections

Another specific feature of acute aortic dissection in terms of presentation and prognosis is the location of the intimal tear and the site of dissection. The Stanford classification describe two types (Figure 2.1):

- Type A: affects the ascending aorta and/or aortic arch and beyond, and

- Type B: affects the descending aorta beyond the left subclavian artery.

Type A dissections (AAD) tend to present more acutely with hemodynamic compromise, either from rupture, tamponade, myocardial ischemia, or neurological dysfunction due to involvement of branch vessels or the aortic arch. The location of the pain is also different, with type A dissections causing more anterior pain and pain resembling angina, and type B dissections (ABAD) often presenting with interscapular pain or back pain.

Type A dissections often progress quickly and give this whole raft of diagnoses a bad name. This is why time is of the essence in managing these patients emergently and effecting urgent surgical repair. Type B dissections can often be managed medically because of less end-organ dysfunction associated with the condition and because the risk of rupture is lower (Table 3.4). The 30-day mortality risk with uncomplicated type B dissections is 10%. The mode of presentation in both types may be remarkably similar, however, and the diagnosis is best made by good-quality imaging performed promptly.

Women

Women were less likely to have AAD (32.1% in one study); however, they tended to be significantly older than men (p < 0.008) and were more likely to have altered mental status or coma than men. Pulse deficit, however, was less common. Women were more likely to have features of rupture (such as periaor-tic hematoma) and pleural or pericardial effusion on diagnostic imaging. Also more common in women are in-hospital complications of tamponade and hypotension. Women with AAD (after adjusting for hypertension and age) were more likely to die than men (OR, 1.4, p < 0.04) and were found to be predominantly in age group 66 to 75 years. AAD in women was associated with a

Table 3.4. Clinical presentation, signs, EKG, and chest radiography in type B aortic dissection

Table 3.4. Clinical presentation, signs, EKG, and chest radiography in type B aortic dissection

Variable

Overall

Survived

Died

P-value

Clinical presentations and signs:

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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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