Acute Aortic Syndromes

Definitions (Circ 2010;121:e266; Eur Heart J 2012;33:26)

  • Aortic dissection: intimal tear → blood extravasates into Ao media (creates false lumen)
  • Intramural hematoma (IMH): vasa vasorum rupture → medial hemorrhage that does not communicate with aortic lumen; 6% of aortic syndromes; clinically managed as AoD
  • Penetrating ulcer: atherosclerotic plaque penetrates elastic lamina → medial hemorrhage

Classification (proximal twice as common as distal)

  • Proximal: involves ascending Ao, regardless of origin (= Stanford A, DeBakey I & II)
  • Distal: involves descending Ao only, distal to L subclavian art. (= Stanford B, DeBakey III)