Aortic Dissection

Good afternoon, ladies and gentleman. It is my great honor to present at this international meeting. I especially thank to Dr. Auria, Kaligis, and Dr. Iwan for inviting me. I would like to talk about the treatment of aortic dissection, especially focused on the comparison between surgical , and endovascular treatment.

Aortic dissectionCommonest aortic emergencyIncidence is twice that of ruptured abdominal aortic aneurysmRare less than 40 years of ageMost commonly seen between 50 and 70 yearsMale:female ratio is equalAssociated with hypertension, Marfans syndrone, bicuspid aortic valve

As you may well know, aortic dissection is one of the commest aortic emergency. The incidence is almost twice that of ruptured AAA. Aortic dissection develop most commonly between the age of 50 and 70.

In aortic dissection, there usually are three component; intimal flap, true lumen and false lumen. We may or may not see the entry tear. The false lumen show free blood flow or throbosis as we can see in this figure.

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This slide shows radiological and histological finding of aortic dissection. Here we can see entry tear, true and false lumen in ascending aorta.

Types of Aortic Syndromes

Classification of Variants of Aortic Dissection

ClassDescription1Separation of intima/media; dual lumens (classic)2Intramural hematoma separation of intima/media; no intraluminal tear or flap imaged3Intimal tear without hematoma (limited dissection) and eccentric bulge4Atherosclerotic penetrating ulcer; ulcer usually penetrating to adventitia with localized hematoma5Iatrogenic/traumatic dissection

Recently we have new classification of variants of aortic dissection. Class 1 lesion is classic aortic dissection, there are entry tear, true lumen and false lumen. Class two lesion is intramural hematoma. Therefore we can not see entry tear or intimal flap. Class three lesion is intimal tear without hematoma. Class 4 lesion is PAU, penetrating aortic ulcer. Class 5 lesion is iatrogenic.

Circulation. 1999;99:1331-1336

Classes of aortic dissection: class 1, classic dissection with flap between true and false aneurysm and clot in false lumen; 2, intramural hematoma; 3, limited intimal tear with eccentric bulge at tear site; 4, penetrating atherosclerotic ulcer with surrounding hematoma, usually subadventitial; 5, iatrogenic or traumatic dissection illustrated by coronary catheter causing dissection.

Therapeutic managementMedical treatmentSurgical treatmentSurgery in type A dissection Surgery in type B dissectionInterventional therapyFenestrationStent-Graft placement

We have three major options for treating aortic dissection; thorse are medical, surgical and interventional. treatment methods are chosen depending on the type of aortic dissection and extent of the lesion.

Interventional Therapy in Aortic DissectionInterventional therapy in aortic dissection provides new approaches to handle complications. Aortic fenestration with or without stent placement allows immediate relief of organ malperfusion for: Visceral / Renal/ Limb ischaemia either before or after surgical treatmentGraft stent implantation is an evolving technique which opens new avenues to treat type B (type III) dissection. Occlusion of entry tears induces thrombus formation and vessel wall healing.

Interventional therapy in type B aortic dissection provide new approaches to handle complications. Endovascular therapy includes fenestration with or without stent and stent-graft implantation.

Stent-Graft in Aortic Dissection

This slide shows the funcation of stent-graft in type B aortic dissection.

Radiology 2001; 220:533-539Percutaneous Separate Stent-Graft

Good afternoon, ladies and gentleman. It is my great honor to present at this international meeting. I especially thank to Dr. Auria, Kaligis, and Dr. Iwan for inviting me. I would like to talk about the treatment of aortic dissection, especially focused on the comparison between surgical , and endovascular treatment.As you may well know, aortic dissection is one of the commest aortic emergency. The incidence is almost twice that of ruptured AAA. Aortic dissection develop most commonly between the age of 50 and 70. In aortic dissection, there usually are three component; intimal flap, true lumen and false lumen. We may or may not see the entry tear. The false lumen show free blood flow or throbosis as we can see in this figure. This slide shows radiological and histological finding of aortic dissection. Here we can see entry tear, true and false lumen in ascending aorta. Recently we have new classification of variants of aortic dissection. Class 1 lesion is classic aortic dissection, there are entry tear, true lumen and false lumen. Class two lesion is intramural hematoma. Therefore we can not see entry tear or intimal flap. Class three lesion is intimal tear without hematoma. Class 4 lesion is PAU, penetrating aortic ulcer. Class 5 lesion is iatrogenic. Classes of aortic dissection: class 1, classic dissection with flap between true and false aneurysm and clot in false lumen; 2, intramural hematoma; 3, limited intimal tear with eccentric bulge at tear site; 4, penetrating atherosclerotic ulcer with surrounding hematoma, usually subadventitial; 5, iatrogenic or traumatic dissection illustrated by coronary catheter causing dissection. We have three major options for treating aortic dissection; thorse are medical, surgical and interventional. treatment methods are chosen depending on the type of aortic dissection and extent of the lesion. Interventional therapy in type B aortic dissection provide new approaches to handle complications. Endovascular therapy includes fenestration with or without stent and stent-graft implantation. This slide shows the funcation of stent-graft in type B aortic dissection.