Case of the Month #30 Aortic Dissection
How does classification influence further management?
- All Stanford type A dissections require surgical intervention with open chest or endovascular repair. (6).
- Uncomplicated Stanford type B dissections can be treated with medical management; extensive follow up imaging is necessary to monitor progression however (1). Thoracic endovascular repair (TEVAR) can be used for patients with high risk complications such as malperfusion on imaging and is performed 2-6 weeks after dissection to prevent false lumen thombosis.
- Complicated Stanford type B dissections i.e. those with persistent pain, rupture (shock, haematoma, haemothorax), malperfusion, uncontrolled hypertension and early aorta expansion would warrant surgical repair. This would be with TEVAR unless the patient had contraindications such as lower extremity vessel disease when open surgery would be used (5).
The gentleman undergoes open repair of his dissection. He is taken to the intensive care unit post-operatively for ongoing management.