Difference between revisions of "Aortic dissection"

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#redirect [[Vascular_disease#Aortic_dissection]]
'''Aortic dissection''', abbreviated '''AoD''', is an uncommon condition with a relatively high mortality.


==General==
Risk factors:
*[[Hypertension]].<ref name=pmid21968475>{{Cite journal  | last1 = Braverman | first1 = AC. | title = Aortic dissection: prompt diagnosis and emergency treatment are critical. | journal = Cleve Clin J Med | volume = 78 | issue = 10 | pages = 685-96 | month = Oct | year = 2011 | doi = 10.3949/ccjm.78a.11053 | PMID = 21968475 | URL = http://www.ccjm.org/content/78/10/685.long }}</ref>
*[[Atherosclerosis]].<ref name=pmid21173794>{{Cite journal  | last1 = LeMaire | first1 = SA. | last2 = Russell | first2 = L. | title = Epidemiology of thoracic aortic dissection. | journal = Nat Rev Cardiol | volume = 8 | issue = 2 | pages = 103-13 | month = Feb | year = 2011 | doi = 10.1038/nrcardio.2010.187 | PMID = 21173794 }}</ref>
**[[Smoking]].
*Cardiac surgery - rare, well-known complication.<ref name=pmid22345184>{{Cite journal  | last1 = Leontyev | first1 = S. | last2 = Borger | first2 = MA. | last3 = Legare | first3 = JF. | last4 = Merk | first4 = D. | last5 = Hahn | first5 = J. | last6 = Seeburger | first6 = J. | last7 = Lehmann | first7 = S. | last8 = Mohr | first8 = FW. | title = Iatrogenic type A aortic dissection during cardiac procedures: early and late outcome in 48 patients. | journal = Eur J Cardiothorac Surg | volume = 41 | issue = 3 | pages = 641-6 | month = Mar | year = 2012 | doi = 10.1093/ejcts/ezr070 | PMID = 22345184 }}</ref>
**In one large registry, approximately 15% of acute dissections are associated with prior cardiac surgery.<ref name=pmid24030404>{{cite journal |author=Teman NR, Peterson MD, Russo MJ, ''et al.'' |title=Outcomes of patients presenting with acute type A aortic dissection in the setting of prior cardiac surgery: an analysis from the International Registry of Acute Aortic Dissection |journal=Circulation |volume=128 |issue=11 Suppl 1 |pages=S180–5 |year=2013 |month=September |pmid=24030404 |doi=10.1161/CIRCULATIONAHA.112.000342 |url=}}</ref>
Note:
*[[Diabetes]] uncommon in thoracic aortic dissection.<ref name=pmid21173794/>
May be separated into two groups:<ref>URL: [http://path.upmc.edu/cases/case84/dx.html http://path.upmc.edu/cases/case84/dx.html]. Accessed on: 13 May 2014.</ref>
#Hypertension + atherosclerosis, typically 40-60 years old.
#Connective tissue disorders - "young".
===Associations===
Heritable:<ref name=pmid16253833>{{cite journal |author=Gleason TG |title=Heritable disorders predisposing to aortic dissection |journal=Semin. Thorac. Cardiovasc. Surg. |volume=17 |issue=3 |pages=274-81 |year=2005 |pmid=16253833 |doi=10.1053/j.semtcvs.2005.06.001 |url=}}</ref>
*[[Marfan's syndrome]].
*Loeys-Dietz syndrome - a Marfan-like syndrome<ref name=pmid16928994>{{cite journal |author=Loeys BL, Schwarze U, Holm T, ''et al'' |title=Aneurysm syndromes caused by mutations in the TGF-beta receptor |journal=N. Engl. J. Med. |volume=355 |issue=8 |pages=788-98 |year=2006 |month=August |pmid=16928994 |doi=10.1056/NEJMoa055695 |url=http://content.nejm.org/cgi/content/full/355/8/788}}</ref>
*[[Ehlers-Danlos syndrome]].
*[[Bicuspid aortic valve]].<ref name=pmid21173794/>
Others:
*Tertiary [[syphilis]].<ref name=pmid20864080>{{Cite journal  | last1 = Cruz | first1 = RP. | last2 = Marrone | first2 = LC. | last3 = Marrone | first3 = AC. | title = Chronic syphilitic aortic aneurysm complicated with chronic aortic dissection. | journal = Am J Surg | volume = 200 | issue = 5 | pages = e64-6 | month = Nov | year = 2010 | doi = 10.1016/j.amjsurg.2010.02.017 | PMID = 20864080 }}</ref>
*[[Turner syndrome]].<ref name=pmid21731587>{{Cite journal  | last1 = Carlson | first1 = M. | last2 = Silberbach | first2 = M. | title = Dissection of the aorta in Turner syndrome: two cases and review of 85 cases in the literature. | journal = BMJ Case Rep | volume = 2009 | issue =  | pages = bcr0620091998 | month =  | year = 2009 | doi = 10.1136/bcr.06.2009.1998 | PMID = 21731587 }}</ref>
===Classification===
Two classification exist:
*''DeBakey''.
*''Stanford''.
Stanford dissection classification:<ref name=pmid9362838>{{cite journal |author=Finkelmeier BA |title=Dissection of the aorta: a clinical update |journal=J Vasc Nurs |volume=15 |issue=3 |pages=88-93 |year=1997 |month=September |pmid=9362838 |doi= |url=}}</ref>
*Type A - aortic root to the left subclavian artery.
**Considered a surgical emergency.
*Type B - distal to (left) subclavian artery.
**Generally, treated conservatively.
==Gross==
*Entry intimal tear +/- exit intimal tear.
**Blood between layers of the vessel wall.
===Images===
<gallery>
Image:AoDiss_Patho.jpg | Aortic dissection. (WC)
</gallery>
www:
*[http://library.med.utah.edu/WebPath/CVHTML/CV031.html Aortic dissection (utah.edu)].
*[http://www.brown.edu/Courses/Digital_Path/systemic_path/cardio/ad-gross.html Aortic dissection (brown.edu)].
==Microscopic==
Features:
*Defect in the tunica media (muscle layer).
*"Abundant" fresh blood in the adventitia.
*+/-Changes of [[cystic medial degeneration]] - a specific histopathologic cause of aortic dissection.
DDx:
*[[Cystic medial degeneration]].
===Images===
<gallery>
Image:Aortic dissection (1) Victoria blue-HE.jpg | Aortic dissection. Victoria blue-H&E. (WC/KGH)
</gallery>
www:
*[http://path.upmc.edu/cases/case84.html Aortic dissection - autopsy (upmc.edu)].
*[http://library.med.utah.edu/WebPath/CVHTML/CV029.html Aortic dissection (utah.edu)].
==Stains==
*[[Alcian blue]]-[[PAS]] - no ground substance - see ''[[cystic medial degeneration]]''.
*[[Elastin stain]] - no extensive fragmentation of the elastin fibres.
==Sign out==
<pre>
PORTION OF AORTA, EXCISION/REPAIR:
- AORTIC WALL WITH EVIDENCE OF DISSECTION.
- NO SIGNIFICANT INFLAMMATION.
- NO MICROORGANISMS IDENTIFIED WITH ROUTINE STAINS.
- NO EVIDENCE OF CYSTIC MEDIAL DEGENERATION, SEE COMMENT.
COMMENT:
An elastic staining does not demonstrate fragmentation of the elastin fibres. No
degenerative changes of the media are apparent with Alcian blue-PAS staining.
</pre>
==See also==
*[[Vascular disease]].
==References==
{{Reflist|2}}
[[Category:Vascular disease]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 19:17, 19 May 2014

Aortic dissection, abbreviated AoD, is an uncommon condition with a relatively high mortality.

General

Risk factors:

Note:

May be separated into two groups:[5]

  1. Hypertension + atherosclerosis, typically 40-60 years old.
  2. Connective tissue disorders - "young".

Associations

Heritable:[6]

Others:

Classification

Two classification exist:

  • DeBakey.
  • Stanford.

Stanford dissection classification:[10]

  • Type A - aortic root to the left subclavian artery.
    • Considered a surgical emergency.
  • Type B - distal to (left) subclavian artery.
    • Generally, treated conservatively.

Gross

  • Entry intimal tear +/- exit intimal tear.
    • Blood between layers of the vessel wall.

Images

  • Aortic dissection. (WC)

www:

Microscopic

Features:

  • Defect in the tunica media (muscle layer).
  • "Abundant" fresh blood in the adventitia.
  • +/-Changes of cystic medial degeneration - a specific histopathologic cause of aortic dissection.

DDx:

Images

  • Aortic dissection. Victoria blue-H&E. (WC/KGH)

www:

Stains

Sign out

PORTION OF AORTA, EXCISION/REPAIR:
- AORTIC WALL WITH EVIDENCE OF DISSECTION.
- NO SIGNIFICANT INFLAMMATION.
- NO MICROORGANISMS IDENTIFIED WITH ROUTINE STAINS.
- NO EVIDENCE OF CYSTIC MEDIAL DEGENERATION, SEE COMMENT.

COMMENT:
An elastic staining does not demonstrate fragmentation of the elastin fibres. No
degenerative changes of the media are apparent with Alcian blue-PAS staining.

See also

References

  1. ↑ Braverman, AC. (Oct 2011). "Aortic dissection: prompt diagnosis and emergency treatment are critical.". Cleve Clin J Med 78 (10): 685-96. doi:10.3949/ccjm.78a.11053. PMID 21968475.
  2. ↑ 2.0 2.1 2.2 LeMaire, SA.; Russell, L. (Feb 2011). "Epidemiology of thoracic aortic dissection.". Nat Rev Cardiol 8 (2): 103-13. doi:10.1038/nrcardio.2010.187. PMID 21173794.
  3. ↑ Leontyev, S.; Borger, MA.; Legare, JF.; Merk, D.; Hahn, J.; Seeburger, J.; Lehmann, S.; Mohr, FW. (Mar 2012). "Iatrogenic type A aortic dissection during cardiac procedures: early and late outcome in 48 patients.". Eur J Cardiothorac Surg 41 (3): 641-6. doi:10.1093/ejcts/ezr070. PMID 22345184.
  4. ↑ Teman NR, Peterson MD, Russo MJ, et al. (September 2013). "Outcomes of patients presenting with acute type A aortic dissection in the setting of prior cardiac surgery: an analysis from the International Registry of Acute Aortic Dissection". Circulation 128 (11 Suppl 1): S180–5. doi:10.1161/CIRCULATIONAHA.112.000342. PMID 24030404.
  5. ↑ URL: http://path.upmc.edu/cases/case84/dx.html. Accessed on: 13 May 2014.
  6. ↑ Gleason TG (2005). "Heritable disorders predisposing to aortic dissection". Semin. Thorac. Cardiovasc. Surg. 17 (3): 274-81. doi:10.1053/j.semtcvs.2005.06.001. PMID 16253833.
  7. ↑ Loeys BL, Schwarze U, Holm T, et al (August 2006). "Aneurysm syndromes caused by mutations in the TGF-beta receptor". N. Engl. J. Med. 355 (8): 788-98. doi:10.1056/NEJMoa055695. PMID 16928994. http://content.nejm.org/cgi/content/full/355/8/788.
  8. ↑ Cruz, RP.; Marrone, LC.; Marrone, AC. (Nov 2010). "Chronic syphilitic aortic aneurysm complicated with chronic aortic dissection.". Am J Surg 200 (5): e64-6. doi:10.1016/j.amjsurg.2010.02.017. PMID 20864080.
  9. ↑ Carlson, M.; Silberbach, M. (2009). "Dissection of the aorta in Turner syndrome: two cases and review of 85 cases in the literature.". BMJ Case Rep 2009: bcr0620091998. doi:10.1136/bcr.06.2009.1998. PMID 21731587.
  10. ↑ Finkelmeier BA (September 1997). "Dissection of the aorta: a clinical update". J Vasc Nurs 15 (3): 88-93. PMID 9362838.
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