DISSECTING ANEURYSM  (Dissecting hematoma)

• Dissecting aneurysm is dissecting hematoma which  occurs when a defect or flap occurs in the intima of the aorta, resulting in blood tracking into the aortic tissues splitting the medial layer and crearing a false lumen.
• MC site is aorta (right lateral wall of ascending aorta)

a) Ascending aorta 70%

b) Descending aorta 63%

  

RISK FACTORS-

• Hypertension (MC)
• Cystic medial necrosis
• Pregnancy
• Marfan syndrome
• Ehler’s Danlos syndrome
• Turner syndrome

 

CLINICAL FEATURES-

• More common in males (50- 70 years)
• Stroke, paraplegia, pericardial tamponade, diaphoresis.
• Abdominal pain

 

CLASSIFICATION-

1. Debakey Classification-

• According to extent of aortic dissection-

1. Type I

• Initimal tear in ascending aorta involving descending aorta (MC)

     2. Type II

• Dissection is limited to ascending aorta.

     3. Type III

• Initimal tear in descending aorta which distal propogation.

  

    B. Standford classification-

• According to clinical management-

1. Type A (proximal dissection)

a) Type A- I and II of Debake’s classification

b) Type B- III Debake’s classification

 

CLINICAL FEATURES-

• Excruciating tearing pain in chest
• Dyspnea
• Weakness
• Hypotension/ shock

 

INVESTIGATIONS-

• Chest X-ray
• Stable- CT angiography
• Unstable- Transesophageal echocardiography

 

TREATMENT-

• Emergency Dacron graft repair

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