acute aortic dissection.pptx

8/20/2019 Acute aortic Dissection.pptx

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Acute Aortic Dissection

• Gangguan yang palingumum yang mengancamkehidupan yangmempengaruhi aorta.

Angka kematian cepatdalam diseksi aortasetinggi 1% per jamselama beberapa jampertama, membuat

diagnosis dini danpengobatan pentinguntuk kelangsunganhidup.

Fig. 1. —Diagram shows three layersof normal aortic wall, from inner toouter intima !"#, media !$#, andadentitia !A#


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Figure 1. Classifcation schemes o

acute aortic dissection. Reprinted withpermission

*kema klasi+kasi untuk diseksi aortadidasarkan pada keterlibatan anatomidari diseksi aorta

Dissection of the descendingpart of the aorta !#, whichstarts from the left subclaianartery and e-tends to the

abdominal aorta !#. /heascending aorta !1# and aortic


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Table. Risk Factors or Aortic Dissection

•0ypertension•Genetically triggered thoracic aortic disease

$arfan syndrome &icuspid aortic ale oeys2Diet3 syndrome 0ereditary /AA4D 5ascular )hlers2Danlos syndrome•6ongenital diseases4syndromes

6oarctation of the aorta /urner syndrome /etralogy of 7allot

•Atherosclerosis8enetrating atherosclerotic ulcer

• /rauma, blunt, or iatrogenic6atheter4stent

"ntraaortic balloon pumpAortic4ascular surgery$otor ehicle accident6oronary artery bypass

surgery4aortic alereplacement

•6ocaine use•"n9ammatory4infectious diseases

Giant cell arteritis /akayasu arteritis&ehe: t diseaseAortitis*yphilis

•8regnancy


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Stanord classifcation /he Acute Aortic *yndrome !AA*# is

classi+ed according to *tanford.Stanord Tpe A lesions inole the ascending aortaand aortic arch and may or may notinole the descending aorta.Stanord Tpe !

lesions inole the thoracic aortadistal to the left subclaian artery.

/he *tanford classi+cation hasreplaced the De&akey classi+cation!type "; ascending, arch and

descending aorta type ""; onlyascending aorta type """; onlydescending aorta#. /reatment options for the ' subgroupsof the acute aortic syndrome !AA*# areery di


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6lassic Aortic Dissection is the most common entity causing an acuteaortic syndrome !=>%#."ncidence 121> 1>>.>>>mostly men?arelyhypertension @ =>% /ype A mortality 12'% per hour after onset of symptoms, total up to>% non2treated,

>% when treated1 year surial /ype & up to BC% if medically treated !C year @ =>%#

Aortic Dissection "A


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Imaging features

In Aortic dissection an intima flap is seen in only 70% of cases.

When there are 2 lumina, these will spiral around each other

(figure.

!n the left consecuti"e images are seen of a #ype $ dissection.

#he true lumen is surrounded y calcifications.

#he true lumen is smaller, as the false lumen wedges around the

true lumen due to permanent systolic pressure (so called $ea&'

sign.#hromus material in"arialy is located in the false lumen, which

enhances later than the true lumen.

True lumen•)urrounded y calcifications (if present•)maller than false lumen•*sually origin of celiac trun&, )+A and right renal artery

False lumen•low or occluded y thromus (chronic.•-elayed enhancement•Wedges around true lumen (ea&'sign•ollageneous media'remnants (cowes•/arger than true lumen•ircular configuration (persistent systolic pressure•!uter cur"e of the arch•*sually origin of left renal artery•)urrounds true lumen in #ype A dissection

•

Type A dissections. The true lumen is surrounded by the false

lumen.

If one of the lumina is surrounded y the other, it in"arialy is the

true lumen.

#his almost only occurs in type A dissections.

#he figures on the left oth show a type A dissection with clearentry points in the ascending aorta.

#he true lumen is surrounded y the false lumen, which is igger


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•

Type B Dissection

!n the left an aortic dissection is seen with a large false lumen.

#he compressed true lumen is seen on the inner side and is righter than the

false lumen.

#hromus formation within the false lumen.#he true lumen usually is smaller as the false lumen wedges around the true

lumen due to permanent systolic pressure.

#he false lumen usually adheres to the outer cur"ature of the aortic arch, as

is seen in this case.


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Cobweb seen within the false lumen

ollageneous media'remnants (cowes are only seen in the false

lumen.#he same holds true for thromusmaterial.


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"f one of the lumina is surrounded by the other, it inariably is the

true lumen. /his almost only occurs in type A dissections. /he +gures on the left both show a type A dissection with clear entrypoints in the ascending aorta. /he true lumen is surrounded by the false lumen, which is bigger andwedges around the true lumen due to permanent systolic pressure.


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acute aortic dissection.pptx

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