37 Aortic Dissection

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Aortic Dissection

Pathogenesis

• intima right next to blood

• can spread distally to abdomen or proximally toward heart

• type A mortality very high, surgery to correct, replace with graft
• HTN drives blood into false lumen

Symptoms

• stretch aortic valve: regurge

• wraps around aorta

• dissection obstructs blood flow to one arm
• mediastinum: 1

Diagnosis

• clots form after blood get into dissection

• contrast CT
• top: aorta
• dissection flap: piece of tissue in middle. Blood broken through layers of aorta and separated aorta
• True lumen: bigger one
• false lumen: space inside flap
• type A:

• type B:

Risks

• aortic dissection requires tension on wall and weakness of media layer
• HTN leads to thick vasa vasorum
• Marfans, Eherlos Danlos

• aortopathy: abnormal aorta, in bicuspiad aortic valve and marfan

Complications

Aortic Aneurysms

• true aneurysms

Thoracic

• often identified by screening

Abdominal

• almost always occur in association with atherosclerosis
• above bifurcation, below renal arteries

Aortic Rupture

• tear through all 3 layers
• elasticity in proximal portion
• rigid in descending portion