Key points: (a) Aortic dissection (AD) is the most common aortic emergency; (b) If untreated, 25-33% of patients with AD die within the first 24 hours, 50-70% die within 48 hours, and 75-80% of patients with undiagnosed AD will die within two weeks; (c) The distinguishing feature of AD is the tearing of the aortic intima; (d) The most common site of intimal tear is within 2-3 centimeters of the aortic valve, with ~90% occurring within 10 centimeters of the aortic valve; (e) There are two commonly used AD classifications – The Stanford classification and the DeBakey classification; (f) More than 30% of acute dissections are not recognized on initial evaluation; (g) Only ~25% of patients with AD have widened mediastinum on antero-posterior radiographs; (h) Contrast-enhanced spiral computed tomography is the initial investigation of choice for the evaluation of suspected AD; (i) Beta-adrenergic antagonists should be administered initially to reduce the rate of change of blood pressure (∆P/∆t) and the shear forces on the aortic wall, with target heart rate of 60-80 beats/minute and target systolic blood pressure around 100-120 mmHg; (j) Stanford Type A dissections are considered surgical emergencies and their prognosis is very poor when unrecognized or treated non-operatively; (k) Stanford Type B dissections may be treated non-surgically, which revolves around strict blood pressure control.

Citation: Stawicki SP, Lindsey DE. ABSITE Corner: Aortic dissection. OPUS 12 Scientist 2009;3(2):30-34.

Keywords: Aortic dissection, Diagnosis, Treatment, Medical imaging, Clinical classification, Surgery, ABSITE.

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