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id="toc-Myocardial_infarction-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pleural_effusion" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pleural_effusion"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.4</span> <span>Pleural effusion</span> </div> </a> <ul id="toc-Pleural_effusion-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Predisposing_factors" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Predisposing_factors"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Predisposing factors</span> </div> </a> <ul id="toc-Predisposing_factors-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Pathophysiology</span> </div> </a> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-D-dimer" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#D-dimer"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>D-dimer</span> </div> </a> <ul id="toc-D-dimer-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Chest_X-ray" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Chest_X-ray"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Chest X-ray</span> </div> </a> <ul id="toc-Chest_X-ray-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Computed_tomography" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Computed_tomography"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Computed tomography</span> </div> </a> <ul id="toc-Computed_tomography-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-MRI" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#MRI"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.4</span> <span>MRI</span> </div> </a> <ul id="toc-MRI-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Ultrasound" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Ultrasound"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.5</span> <span>Ultrasound</span> </div> </a> <ul id="toc-Ultrasound-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Aortogram" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Aortogram"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.6</span> <span>Aortogram</span> </div> </a> <ul id="toc-Aortogram-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Classification" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Classification"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Classification</span> </div> </a> <button aria-controls="toc-Classification-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Classification subsection</span> </button> <ul id="toc-Classification-sublist" class="vector-toc-list"> <li id="toc-DeBakey" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#DeBakey"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>DeBakey</span> </div> </a> <ul id="toc-DeBakey-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Stanford" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Stanford"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Stanford</span> </div> </a> <ul id="toc-Stanford-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Prevention</span> </div> </a> <ul id="toc-Prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Management" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Management"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Management</span> </div> </a> <button aria-controls="toc-Management-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Management subsection</span> </button> <ul id="toc-Management-sublist" class="vector-toc-list"> <li id="toc-Medication" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medication"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.1</span> <span>Medication</span> </div> </a> <ul id="toc-Medication-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Surgical" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Surgical"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.2</span> <span>Surgical</span> </div> </a> <ul id="toc-Surgical-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Follow-up" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Follow-up"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.3</span> <span>Follow-up</span> </div> </a> <ul id="toc-Follow-up-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Prognosis</span> </div> </a> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>History</span> </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Well-known_patients" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Well-known_patients"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>Well-known patients</span> </div> </a> <ul id="toc-Well-known_patients-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">12</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">13</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Sources" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Sources"> <div class="vector-toc-text"> <span class="vector-toc-numb">14</span> <span>Sources</span> </div> </a> <ul id="toc-Sources-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">15</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Aortic dissection</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 33 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-33" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">33 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%AA%D8%B3%D9%84%D8%AE_%D8%A7%D9%84%D8%A3%D8%A8%D9%87%D8%B1" title="تسلخ الأبهر – Arabic" lang="ar" hreflang="ar" data-title="تسلخ الأبهر" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%D8%A2%D9%88%D8%B1%D8%AA%D8%A7_%D8%B3%D9%8A%D8%B2%DA%A9%D8%B3%D9%8A%D9%88%D9%86" title="آورتا سيزکسيون – South Azerbaijani" lang="azb" hreflang="azb" data-title="آورتا سيزکسيون" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target"><span>تۆرکجه</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%94%D0%B8%D1%81%D0%B5%D0%BA%D0%B0%D1%86%D0%B8%D1%8F_%D0%BD%D0%B0_%D0%B0%D0%BE%D1%80%D1%82%D0%B0%D1%82%D0%B0" title="Дисекация на аортата – Bulgarian" lang="bg" hreflang="bg" data-title="Дисекация на аортата" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Dissecci%C3%B3_a%C3%B2rtica" title="Dissecció aòrtica – Catalan" lang="ca" hreflang="ca" data-title="Dissecció aòrtica" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Disekce_aorty" title="Disekce aorty – Czech" lang="cs" hreflang="cs" data-title="Disekce aorty" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Aortadissektion" title="Aortadissektion – Danish" lang="da" hreflang="da" data-title="Aortadissektion" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-de badge-Q17437796 badge-featuredarticle mw-list-item" title="featured article badge"><a href="https://de.wikipedia.org/wiki/Aortendissektion" title="Aortendissektion – German" lang="de" hreflang="de" data-title="Aortendissektion" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Disecci%C3%B3n_a%C3%B3rtica" title="Disección aórtica – Spanish" lang="es" hreflang="es" data-title="Disección aórtica" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Dissection_aortique" title="Dissection aortique – French" lang="fr" hreflang="fr" data-title="Dissection aortique" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%8C%80%EB%8F%99%EB%A7%A5_%EB%B0%95%EB%A6%AC" title="대동맥 박리 – Korean" lang="ko" hreflang="ko" data-title="대동맥 박리" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D4%B1%D5%B8%D6%80%D5%BF%D5%A1%D5%B5%D5%AB_%D5%B7%D5%A5%D6%80%D5%BF%D5%A1%D5%A6%D5%A1%D5%BF%D5%B8%D6%82%D5%B4" title="Աորտայի շերտազատում – Armenian" lang="hy" hreflang="hy" data-title="Աորտայի շերտազատում" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Disekcija_aorte" title="Disekcija aorte – Croatian" lang="hr" hreflang="hr" data-title="Disekcija aorte" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-ig mw-list-item"><a href="https://ig.wikipedia.org/wiki/Aortic_dissection" title="Aortic dissection – Igbo" lang="ig" hreflang="ig" data-title="Aortic dissection" data-language-autonym="Igbo" data-language-local-name="Igbo" class="interlanguage-link-target"><span>Igbo</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Diseksi_aorta" title="Diseksi aorta – Indonesian" lang="id" hreflang="id" data-title="Diseksi aorta" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Dissecazione_aortica" title="Dissecazione aortica – Italian" lang="it" hreflang="it" data-title="Dissecazione aortica" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he badge-Q17437796 badge-featuredarticle mw-list-item" title="featured article badge"><a href="https://he.wikipedia.org/wiki/%D7%91%D7%AA%D7%99%D7%A8%D7%AA_%D7%90%D7%91%D7%99_%D7%94%D7%A2%D7%95%D7%A8%D7%A7%D7%99%D7%9D" title="בתירת אבי העורקים – Hebrew" lang="he" hreflang="he" data-title="בתירת אבי העורקים" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Pembedahan_aorta" title="Pembedahan aorta – Malay" lang="ms" hreflang="ms" data-title="Pembedahan aorta" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Aortadissectie" title="Aortadissectie – Dutch" lang="nl" hreflang="nl" data-title="Aortadissectie" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-new mw-list-item"><a href="https://new.wikipedia.org/wiki/%E0%A4%8F%E0%A4%93%E0%A4%B0%E0%A5%8D%E0%A4%A4%E0%A4%BF%E0%A4%95_%E0%A4%A6%E0%A4%BF%E0%A4%B8%E0%A5%87%E0%A4%95%E0%A5%8D%E0%A4%B8%E0%A4%A8" title="एओर्तिक दिसेक्सन – Newari" lang="new" hreflang="new" data-title="एओर्तिक दिसेक्सन" data-language-autonym="नेपाल भाषा" data-language-local-name="Newari" class="interlanguage-link-target"><span>नेपाल भाषा</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E5%A4%A7%E5%8B%95%E8%84%88%E8%A7%A3%E9%9B%A2" title="大動脈解離 – Japanese" lang="ja" hreflang="ja" data-title="大動脈解離" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%AE%E0%AC%B9%E0%AC%BE%E0%AC%A7%E0%AC%AE%E0%AC%A8%E0%AD%80_%E0%AC%AC%E0%AD%8D%E0%AD%9F%E0%AC%AC%E0%AC%9A%E0%AD%8D%E0%AC%9B%E0%AD%87%E0%AC%A6%E0%AC%A8" title="ମହାଧମନୀ ବ୍ୟବଚ୍ଛେଦନ – Odia" lang="or" hreflang="or" data-title="ମହାଧମନୀ ବ୍ୟବଚ୍ଛେଦନ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/T%C4%99tniak_rozwarstwiaj%C4%85cy" title="Tętniak rozwarstwiający – Polish" lang="pl" hreflang="pl" data-title="Tętniak rozwarstwiający" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Dissec%C3%A7%C3%A3o_da_aorta" title="Dissecção da aorta – Portuguese" lang="pt" hreflang="pt" data-title="Dissecção da aorta" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A0%D0%B0%D1%81%D1%81%D0%BB%D0%BE%D0%B5%D0%BD%D0%B8%D0%B5_%D0%B0%D0%BE%D1%80%D1%82%D1%8B" title="Расслоение аорты – Russian" lang="ru" hreflang="ru" data-title="Расслоение аорты" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-szy mw-list-item"><a href="https://szy.wikipedia.org/wiki/mapudac_ku_satabakiay_a_ulat" title="mapudac ku satabakiay a ulat – Sakizaya" lang="szy" hreflang="szy" data-title="mapudac ku satabakiay a ulat" data-language-autonym="Sakizaya" data-language-local-name="Sakizaya" class="interlanguage-link-target"><span>Sakizaya</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Aortic_dissection" title="Aortic dissection – Simple English" lang="en-simple" hreflang="en-simple" data-title="Aortic dissection" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%94%D0%B8%D1%81%D0%B5%D0%BA%D1%86%D0%B8%D1%98%D0%B0_%D0%B0%D0%BE%D1%80%D1%82%D0%B5" title="Дисекција аорте – Serbian" lang="sr" hreflang="sr" data-title="Дисекција аорте" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Disekcija_aorte" title="Disekcija aorte – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Disekcija aorte" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Aortadissektion" title="Aortadissektion – Swedish" lang="sv" hreflang="sv" data-title="Aortadissektion" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%81%E0%B8%B2%E0%B8%A3%E0%B8%89%E0%B8%B5%E0%B8%81%E0%B9%80%E0%B8%8B%E0%B8%B2%E0%B8%B0%E0%B8%82%E0%B8%AD%E0%B8%87%E0%B9%80%E0%B8%AD%E0%B8%AD%E0%B8%AD%E0%B8%A3%E0%B9%8C%E0%B8%95%E0%B8%B2" title="การฉีกเซาะของเอออร์ตา – Thai" lang="th" 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.hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Not to be confused with <a href="/wiki/Abdominal_aortic_aneurysm" title="Abdominal aortic aneurysm">Abdominal aortic aneurysm</a> or <a href="/wiki/Aortic_rupture" title="Aortic rupture">Aortic rupture</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Aortic dissection</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:AoDissekt_scheme_StanfordB_en.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d4/AoDissekt_scheme_StanfordB_en.png/220px-AoDissekt_scheme_StanfordB_en.png" decoding="async" width="220" height="265" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d4/AoDissekt_scheme_StanfordB_en.png/330px-AoDissekt_scheme_StanfordB_en.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d4/AoDissekt_scheme_StanfordB_en.png/440px-AoDissekt_scheme_StanfordB_en.png 2x" data-file-width="540" data-file-height="650" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">Stanford type B dissection of the <a href="/wiki/Descending_aorta" title="Descending aorta">descending part of the aorta</a> (3), which starts from the <a href="/wiki/Left_subclavian_artery" class="mw-redirect" title="Left subclavian artery">left subclavian artery</a> and extends to the <a href="/wiki/Abdominal_aorta" title="Abdominal aorta">abdominal aorta</a> (4). The <a href="/wiki/Ascending_aorta" title="Ascending aorta">ascending aorta</a> (1) and <a href="/wiki/Aortic_arch" title="Aortic arch">aortic arch</a> (2) shown in the image are not involved in this condition.</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Vascular_surgery" title="Vascular surgery">Vascular surgery</a>, <a href="/wiki/Cardiothoracic_surgery" title="Cardiothoracic surgery">cardiothoracic surgery</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">severe <a href="/wiki/Acute_aortic_syndrome" title="Acute aortic syndrome">chest or back pain</a>, vomiting, <a href="/wiki/Diaphoresis" class="mw-redirect" title="Diaphoresis">sweating</a>, <a href="/wiki/Lightheadedness" title="Lightheadedness">lightheadedness</a><sup id="cite_ref-Lancet2016_1-0" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-White2013_2-0" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data"><a href="/wiki/Stroke" title="Stroke">Stroke</a>, <a href="/wiki/Mesenteric_ischemia" class="mw-redirect" title="Mesenteric ischemia">mesenteric ischemia</a>, <a href="/wiki/Myocardial_ischemia" class="mw-redirect" title="Myocardial ischemia">myocardial ischemia</a>, <a href="/wiki/Aortic_rupture" title="Aortic rupture">aortic rupture</a><sup id="cite_ref-White2013_2-1" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">Sudden<sup id="cite_ref-Lancet2016_1-1" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-White2013_2-2" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data"><a href="/wiki/Hypertension" title="Hypertension">High blood pressure</a>, <a href="/wiki/Marfan_syndrome" title="Marfan syndrome">Marfan syndrome</a>, <a href="/wiki/Loeys-Dietz_Syndrome" class="mw-redirect" title="Loeys-Dietz Syndrome">Loeys-Dietz Syndrome</a>, <a href="/wiki/Turner_syndrome" title="Turner syndrome">Turner syndrome</a>, <a href="/wiki/Bicuspid_aortic_valve" title="Bicuspid aortic valve">bicuspid aortic valve</a>, previous <a href="/wiki/Heart_surgery" class="mw-redirect" title="Heart surgery">heart surgery</a>, <a href="/wiki/Major_trauma" title="Major trauma">major trauma</a>, <a href="/wiki/Smoking" title="Smoking">smoking</a><sup id="cite_ref-Lancet2016_1-2" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-White2013_2-3" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Criado2011_3-0" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data"><a href="/wiki/Medical_imaging" title="Medical imaging">Medical imaging</a><sup id="cite_ref-Lancet2016_1-3" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Prevention</th><td class="infobox-data">Blood pressure control, not smoking <sup id="cite_ref-Lancet2016_1-4" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Depends on the type<sup id="cite_ref-Lancet2016_1-5" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">Mortality without treatment 10% (type B), 50% (type A)<sup id="cite_ref-Criado2011_3-1" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">3 per 100,000 per year<sup id="cite_ref-Criado2011_3-2" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <figure class="mw-default-size" typeof="mw:File/Thumb"><span><video id="mwe_player_5" poster="//upload.wikimedia.org/wikipedia/commons/thumb/2/2d/Aortic_dissection.webm/220px--Aortic_dissection.webm.jpg" controls="" preload="none" data-mw-tmh="" class="mw-file-element" width="220" height="124" data-durationhint="324" data-mwtitle="Aortic_dissection.webm" data-mwprovider="wikimediacommons" resource="/wiki/File:Aortic_dissection.webm"><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/2/2d/Aortic_dissection.webm/Aortic_dissection.webm.480p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="480p.vp9.webm" data-width="852" data-height="480" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/2/2d/Aortic_dissection.webm/Aortic_dissection.webm.720p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="720p.vp9.webm" data-width="1278" data-height="720" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/2/2d/Aortic_dissection.webm/Aortic_dissection.webm.1080p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="1080p.vp9.webm" data-width="1918" data-height="1080" /><source src="//upload.wikimedia.org/wikipedia/commons/2/2d/Aortic_dissection.webm" type="video/webm; codecs="vp9, vorbis"" data-width="1918" data-height="1080" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/2/2d/Aortic_dissection.webm/Aortic_dissection.webm.144p.mjpeg.mov" type="video/quicktime" data-transcodekey="144p.mjpeg.mov" data-width="256" data-height="144" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/2/2d/Aortic_dissection.webm/Aortic_dissection.webm.240p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="240p.vp9.webm" data-width="426" data-height="240" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/2/2d/Aortic_dissection.webm/Aortic_dissection.webm.360p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="360p.vp9.webm" data-width="640" data-height="360" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/2/2d/Aortic_dissection.webm/Aortic_dissection.webm.360p.webm" type="video/webm; codecs="vp8, vorbis"" data-transcodekey="360p.webm" data-width="640" data-height="360" /><track src="https://commons.wikimedia.org/w/api.php?action=timedtext&title=File%3AAortic_dissection.webm&lang=ar&trackformat=vtt&origin=%2A" kind="subtitles" type="text/vtt" srclang="ar" label="العربية ‪(ar)‬" data-dir="rtl" /><track src="https://commons.wikimedia.org/w/api.php?action=timedtext&title=File%3AAortic_dissection.webm&lang=en&trackformat=vtt&origin=%2A" kind="subtitles" type="text/vtt" srclang="en" label="English ‪(en)‬" data-dir="ltr" /><track src="https://commons.wikimedia.org/w/api.php?action=timedtext&title=File%3AAortic_dissection.webm&lang=es&trackformat=vtt&origin=%2A" kind="subtitles" type="text/vtt" srclang="es" label="español ‪(es)‬" data-dir="ltr" /><track src="https://commons.wikimedia.org/w/api.php?action=timedtext&title=File%3AAortic_dissection.webm&lang=it&trackformat=vtt&origin=%2A" kind="subtitles" type="text/vtt" srclang="it" label="italiano ‪(it)‬" data-dir="ltr" /><track src="https://commons.wikimedia.org/w/api.php?action=timedtext&title=File%3AAortic_dissection.webm&lang=ja&trackformat=vtt&origin=%2A" kind="subtitles" type="text/vtt" srclang="ja" label="日本語 ‪(ja)‬" data-dir="ltr" /><track src="https://commons.wikimedia.org/w/api.php?action=timedtext&title=File%3AAortic_dissection.webm&lang=pt&trackformat=vtt&origin=%2A" kind="subtitles" type="text/vtt" srclang="pt" label="português ‪(pt)‬" data-dir="ltr" /><track src="https://commons.wikimedia.org/w/api.php?action=timedtext&title=File%3AAortic_dissection.webm&lang=ru&trackformat=vtt&origin=%2A" kind="subtitles" type="text/vtt" srclang="ru" label="русский ‪(ru)‬" data-dir="ltr" /><track src="https://commons.wikimedia.org/w/api.php?action=timedtext&title=File%3AAortic_dissection.webm&lang=zh&trackformat=vtt&origin=%2A" kind="subtitles" type="text/vtt" srclang="zh" label="中文 ‪(zh)‬" data-dir="ltr" /></video></span><figcaption>Aortic dissection explanation video</figcaption></figure> <p><b>Aortic dissection</b> (<b>AD</b>) occurs when an injury to the <a href="/wiki/Tunica_intima" title="Tunica intima">innermost layer</a> of the <a href="/wiki/Aorta" title="Aorta">aorta</a> allows blood to flow between the layers of the aortic wall, <a href="/wiki/Dissection_(medical)" class="mw-redirect" title="Dissection (medical)">forcing the layers apart</a>.<sup id="cite_ref-Criado2011_3-3" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> In most cases, this is associated with a sudden onset of agonizing <a href="/wiki/Acute_aortic_syndrome" title="Acute aortic syndrome">chest or back pain</a>, often described as "tearing" in character.<sup id="cite_ref-Lancet2016_1-6" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-White2013_2-4" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Vomiting, <a href="/wiki/Diaphoresis" class="mw-redirect" title="Diaphoresis">sweating</a>, and <a href="/wiki/Lightheadedness" title="Lightheadedness">lightheadedness</a> may also occur.<sup id="cite_ref-White2013_2-5" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Damage to other organs may result from the decreased blood supply, such as <a href="/wiki/Stroke" title="Stroke">stroke</a>, lower extremity ischemia, or <a href="/wiki/Mesenteric_ischemia" class="mw-redirect" title="Mesenteric ischemia">mesenteric ischemia</a>.<sup id="cite_ref-White2013_2-6" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Aortic dissection can quickly lead to death from <a href="/wiki/Myocardial_ischemia" class="mw-redirect" title="Myocardial ischemia">insufficient blood flow to the heart</a> or complete <a href="/wiki/Aortic_rupture" title="Aortic rupture">rupture of the aorta</a>.<sup id="cite_ref-White2013_2-7" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>AD is more common in those with a history of <a href="/wiki/Hypertension" title="Hypertension">high blood pressure</a>; a number of <a href="/wiki/Connective_tissue_disease" title="Connective tissue disease">connective tissue diseases</a> that affect blood vessel wall strength including <a href="/wiki/Marfan_syndrome" title="Marfan syndrome">Marfan syndrome</a> and <a href="/wiki/Ehlers%E2%80%93Danlos_syndrome" title="Ehlers–Danlos syndrome">Ehlers–Danlos syndrome</a>; a <a href="/wiki/Bicuspid_aortic_valve" title="Bicuspid aortic valve">bicuspid aortic valve</a>; and previous <a href="/wiki/Heart_surgery" class="mw-redirect" title="Heart surgery">heart surgery</a>.<sup id="cite_ref-White2013_2-8" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Criado2011_3-4" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Major_trauma" title="Major trauma">Major trauma</a>, <a href="/wiki/Smoking" title="Smoking">smoking</a>, <a href="/wiki/Cocaine" title="Cocaine">cocaine</a> use, <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a>, a <a href="/wiki/Thoracic_aortic_aneurysm" title="Thoracic aortic aneurysm">thoracic aortic aneurysm</a>, <a href="/wiki/Arteritis" title="Arteritis">inflammation of arteries</a>, and <a href="/wiki/Dyslipidemia" title="Dyslipidemia">abnormal lipid levels</a> are also associated with an increased risk.<sup id="cite_ref-Lancet2016_1-7" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-White2013_2-9" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The diagnosis is suspected based on symptoms with <a href="/wiki/Medical_imaging" title="Medical imaging">medical imaging</a>, such as <a href="/wiki/CT_scan" title="CT scan">CT scan</a>, <a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">MRI</a>, or <a href="/wiki/Echocardiography" title="Echocardiography">ultrasound</a> used to confirm and further evaluate the dissection.<sup id="cite_ref-Lancet2016_1-8" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The two main types are Stanford type A, which involves the <a href="/wiki/Ascending_aorta" title="Ascending aorta">first part of the aorta</a>, and type B, which does not.<sup id="cite_ref-Lancet2016_1-9" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Prevention is by blood pressure control and smoking cessation.<sup id="cite_ref-Lancet2016_1-10" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Management of AD depends on the part of the aorta involved.<sup id="cite_ref-Lancet2016_1-11" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Dissections that involve the first part of the aorta (adjacent to the heart) usually require surgery.<sup id="cite_ref-Lancet2016_1-12" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-White2013_2-10" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Surgery may be done either by an <a href="/wiki/Open_aortic_surgery" title="Open aortic surgery">opening in the chest</a> or from <a href="/wiki/Endovascular_aneurysm_repair" title="Endovascular aneurysm repair">inside the blood vessel</a>.<sup id="cite_ref-Lancet2016_1-13" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Dissections that involve the second part of the aorta can typically be treated with medications that lower blood pressure and heart rate, unless there are complications which then require surgical correction.<sup id="cite_ref-Lancet2016_1-14" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-White2013_2-11" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>AD is relatively rare, occurring at an estimated rate of three per 100,000 people per year.<sup id="cite_ref-Lancet2016_1-15" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Criado2011_3-5" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> It is more common in men than women.<sup id="cite_ref-Lancet2016_1-16" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The typical age at diagnosis is 63, with about 10% of cases occurring before the age of 40.<sup id="cite_ref-Lancet2016_1-17" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Criado2011_3-6" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Without treatment, about half of people with Stanford type A dissections die within three days and about 10% of people with Stanford type B dissections die within one month.<sup id="cite_ref-Criado2011_3-7" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The first case of AD was described in the examination of <a href="/wiki/George_II_of_Great_Britain" title="George II of Great Britain">King George II of Great Britain</a> following his death in 1760.<sup id="cite_ref-Criado2011_3-8" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Surgery for AD was introduced in the 1950s by <a href="/wiki/Michael_E._DeBakey" class="mw-redirect" title="Michael E. DeBakey">Michael E. DeBakey</a>.<sup id="cite_ref-Criado2011_3-9" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>About 96% of individuals with AD present with severe pain that had a sudden onset. The pain may be described as a tearing, stabbing, or sharp sensation in the chest, back, or abdomen.<sup id="cite_ref-ReferenceA_4-0" class="reference"><a href="#cite_note-ReferenceA-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-BonowMann2011_5-0" class="reference"><a href="#cite_note-BonowMann2011-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> About 17% of individuals feel the pain migrate as the dissection extends down the aorta.<sup id="cite_ref-MarxWalls2013_6-0" class="reference"><a href="#cite_note-MarxWalls2013-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> The location of pain is associated with the location of the dissection.<sup id="cite_ref-Elefteriades2007_7-0" class="reference"><a href="#cite_note-Elefteriades2007-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Anterior" class="mw-redirect" title="Anterior">Anterior</a> chest pain is associated with dissections involving the ascending aorta, while interscapular back pain is associated with descending aortic dissections. If the pain is <a href="/wiki/Pleurisy" title="Pleurisy">pleuritic</a> in nature, it may suggest acute <a href="/wiki/Pericarditis" title="Pericarditis">pericarditis</a> caused by bleeding into the <a href="/wiki/Pericardium" title="Pericardium">sac surrounding the heart</a>. This is a particularly dangerous eventuality, suggesting that acute <a href="/wiki/Pericardial_tamponade" class="mw-redirect" title="Pericardial tamponade">pericardial tamponade</a> may be imminent. Pericardial tamponade is the most common cause of death from AD.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>While the pain may be confused with that of a <a href="/wiki/Myocardial_infarction" title="Myocardial infarction">heart attack</a>, AD is usually not associated with the other suggestive signs, such as <a href="/wiki/Heart_failure" title="Heart failure">heart failure</a> and <a href="/wiki/ECG" class="mw-redirect" title="ECG">ECG</a> changes. Less common symptoms that may be seen in the setting of AD include <a href="/wiki/Congestive_heart_failure" class="mw-redirect" title="Congestive heart failure">congestive heart failure</a> (7%), <a href="/wiki/Syncope_(medicine)" title="Syncope (medicine)">fainting</a> (9%), <a href="/wiki/Stroke" title="Stroke">stroke</a> (6%), ischemic <a href="/wiki/Peripheral_neuropathy" title="Peripheral neuropathy">peripheral neuropathy</a>, <a href="/wiki/Paraplegia" title="Paraplegia">paraplegia</a>, and <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a>.<sup id="cite_ref-She2013_9-0" class="reference"><a href="#cite_note-She2013-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> If the individual fainted, about half the time it is due to bleeding into the pericardium, leading to pericardial tamponade. Neurological complications of aortic dissection, such as <a href="/wiki/Stroke" title="Stroke">stroke</a> and <a href="/wiki/Paralysis" title="Paralysis">paralysis</a>, are due to the involvement of one or more arteries supplying portions of the <a href="/wiki/Central_nervous_system" title="Central nervous system">central nervous system</a>.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>If the AD involves the abdominal aorta, compromise of one or both <a href="/wiki/Renal_artery" title="Renal artery">renal arteries</a> occurs in 5–8% of cases, while <a href="/wiki/Mesenteric_ischemia" class="mw-redirect" title="Mesenteric ischemia">ischemia of the intestines</a> occurs about 3% of the time.<sup id="cite_ref-pmid26024781_11-0" class="reference"><a href="#cite_note-pmid26024781-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid28823323_12-0" class="reference"><a href="#cite_note-pmid28823323-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Blood_pressure">Blood pressure</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=2" title="Edit section: Blood pressure"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>People with AD often have a history of <a href="/wiki/Hypertension" title="Hypertension">high blood pressure</a>. The blood pressure is quite variable at presentation with acute AD. It tends to be higher in individuals with a distal dissection. In individuals with a proximal AD, 36% present with hypertension, while 25% present with <a href="/wiki/Hypotension" title="Hypotension">hypotension</a>. Proximal AD tends to be associated with weakening of the vascular wall due to <a href="/wiki/Cystic_medial_degeneration" class="mw-redirect" title="Cystic medial degeneration">cystic medial degeneration</a>. In those who present with distal (Stanford type B) AD, 60–70% present with high blood pressure, while 2–3% present with <a href="/wiki/Hypotension" title="Hypotension">low blood pressure</a>.<sup id="cite_ref-Alfson2017_13-0" class="reference"><a href="#cite_note-Alfson2017-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>Severe hypotension at presentation is a grave prognostic indicator. It is usually associated with pericardial tamponade, severe aortic insufficiency, or rupture of the aorta. Accurate measurement of blood pressure is important. Pseudohypotension (falsely low blood-pressure measurement) may occur due to involvement of the <a href="/wiki/Brachiocephalic_artery" title="Brachiocephalic artery">brachiocephalic artery</a> (supplying the right arm) or the <a href="/wiki/Subclavian_artery" title="Subclavian artery">left subclavian artery</a> (supplying the left arm).<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Aortic_insufficiency">Aortic insufficiency</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=3" title="Edit section: Aortic insufficiency"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Aortic_insufficiency" class="mw-redirect" title="Aortic insufficiency">Aortic insufficiency</a> (AI) occurs in half to two-thirds of ascending AD, and the diastolic <a href="/wiki/Heart_sounds" title="Heart sounds">heart murmur</a> of aortic insufficiency is audible in about 32% of proximal dissections. The intensity (loudness) of the murmur depends on the blood pressure and may be inaudible in the event of low blood pressure.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p>Multiple causes exist for AI in the setting of ascending AD. The dissection may dilate the annulus of the <a href="/wiki/Aortic_valve" title="Aortic valve">aortic valve</a>, preventing the leaflets of the valve from coapting. The dissection may extend into the aortic root and detach the aortic valve leaflets. Alternatively, following an extensive intimal tear, the intimal flap may prolapse into the <a href="/wiki/Left_ventricular_outflow_tract" class="mw-redirect" title="Left ventricular outflow tract">left ventricular outflow tract</a>, causing intimal <a href="/wiki/Intussusception_(blood_vessel_growth)" class="mw-redirect" title="Intussusception (blood vessel growth)">intussusception</a> into the aortic valve, thereby preventing proper valve closure.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Myocardial_infarction">Myocardial infarction</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=4" title="Edit section: Myocardial infarction"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Myocardial_infarction" title="Myocardial infarction">Heart attack</a> occurs in 1–2% of aortic dissections. Infarction is caused by the involvement of the <a href="/wiki/Coronary_artery" class="mw-redirect" title="Coronary artery">coronary arteries</a>, which supply the heart with oxygenated blood, in the dissection. The right coronary artery is involved more commonly than the left coronary artery. If the myocardial infarction is treated with <a href="/wiki/Thrombolytic" class="mw-redirect" title="Thrombolytic">thrombolytic</a> therapy, the mortality increases to over 70%, mostly due to bleeding into the pericardial sac, causing <a href="/wiki/Cardiac_tamponade" title="Cardiac tamponade">cardiac tamponade</a>.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Pleural_effusion">Pleural effusion</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=5" title="Edit section: Pleural effusion"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A <a href="/wiki/Pleural_effusion" title="Pleural effusion">pleural effusion</a> (fluid collection in the space between the <a href="/wiki/Lung" title="Lung">lungs</a> and the chest wall or <a href="/wiki/Diaphragm_(anatomy)" class="mw-redirect" title="Diaphragm (anatomy)">diaphragm</a>) can be due to either blood from a transient rupture of the aorta or fluid due to an inflammatory reaction around the aorta. If a pleural effusion were to develop due to AD, it is more common in the left hemithorax rather than the right hemithorax.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Predisposing_factors">Predisposing factors</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=6" title="Edit section: Predisposing factors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Aortic dissection is associated with <a href="/wiki/Hypertension" title="Hypertension">hypertension</a> (high blood pressure) and many <a href="/wiki/Connective_tissue" title="Connective tissue">connective tissue</a> disorders. <a href="/wiki/Vasculitis" title="Vasculitis">Vasculitis</a> (<a href="/wiki/Inflammation" title="Inflammation">inflammation</a> of an artery) is rarely associated with aortic dissection. It can also be the result of chest trauma. About 72 to 80% of individuals who present with an aortic dissection have a previous history of hypertension. Illicit drug use with stimulants such as <a href="/wiki/Cocaine" title="Cocaine">cocaine</a> and <a href="/wiki/Methamphetamine" title="Methamphetamine">methamphetamine</a> is also a modifiable risk factor for AD.<sup id="cite_ref-Lech2017_20-0" class="reference"><a href="#cite_note-Lech2017-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid25657055_21-0" class="reference"><a href="#cite_note-pmid25657055-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> It can also be caused by smoking. </p><p>A <a href="/wiki/Bicuspid_aortic_valve" title="Bicuspid aortic valve">bicuspid aortic valve</a> (a type of <a href="/wiki/Congenital_heart_disease" class="mw-redirect" title="Congenital heart disease">congenital heart disease</a> involving the <a href="/wiki/Aortic_valve" title="Aortic valve">aortic valve</a>) is found in 7–14% of individuals who have an aortic dissection. These individuals are prone to dissection in the ascending aorta. The risk of dissection in individuals with bicuspid aortic valves is not associated with the degree of <a href="/wiki/Aortic_stenosis" title="Aortic stenosis">stenosis</a> of the valve.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p><a href="/wiki/Connective_tissue_disorder" class="mw-redirect" title="Connective tissue disorder">Connective tissue disorders</a> such as <a href="/wiki/Marfan_syndrome" title="Marfan syndrome">Marfan syndrome</a>, <a href="/wiki/Ehlers%E2%80%93Danlos_syndromes" class="mw-redirect" title="Ehlers–Danlos syndromes">Ehlers–Danlos syndrome</a>, and <a href="/wiki/Loeys%E2%80%93Dietz_syndrome" title="Loeys–Dietz syndrome">Loeys–Dietz syndrome</a> increase the risk of aortic dissection.<sup id="cite_ref-Alfson2017_13-1" class="reference"><a href="#cite_note-Alfson2017-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Similarly, vasculitides such as <a href="/wiki/Takayasu%27s_arteritis" title="Takayasu's arteritis">Takayasu's arteritis</a>, <a href="/wiki/Giant_cell_arteritis" title="Giant cell arteritis">giant cell arteritis</a>, <a href="/wiki/Polyarteritis_nodosa" title="Polyarteritis nodosa">polyarteritis nodosa</a>, and <a href="/wiki/Beh%C3%A7et%27s_disease" title="Behçet's disease">Behçet's disease</a> have been associated with a subsequent aortic dissection.<sup id="cite_ref-Alfson2017_13-2" class="reference"><a href="#cite_note-Alfson2017-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Lech2017_20-1" class="reference"><a href="#cite_note-Lech2017-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Marfan Syndrome is found in 5–9% of individuals who had an aortic dissection. In this subset, the incidence in young individuals is increased. Individuals with Marfan syndrome tend to have aneurysms of the aorta and are more prone to proximal dissections of the aorta.<sup id="cite_ref-pmid24443022_22-0" class="reference"><a href="#cite_note-pmid24443022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Turner_syndrome" title="Turner syndrome">Turner syndrome</a> also increases the risk of aortic dissection, by aortic root dilatation.<sup id="cite_ref-Turner2006_23-0" class="reference"><a href="#cite_note-Turner2006-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p><p>Chest trauma leading to aortic dissection can be divided into two groups based on cause: blunt chest trauma (commonly seen in <a href="/wiki/Car_accident" class="mw-redirect" title="Car accident">car accidents</a>) and <a href="/wiki/Iatrogenic" class="mw-redirect" title="Iatrogenic">iatrogenic</a>. Iatrogenic causes include trauma during <a href="/wiki/Cardiac_catheterization" title="Cardiac catheterization">cardiac catheterization</a> or due to an <a href="/wiki/Intra-aortic_balloon_pump" title="Intra-aortic balloon pump">intra-aortic balloon pump</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>Aortic dissection may be a late sequela of <a href="/wiki/Cardiac_surgery" title="Cardiac surgery">heart surgery</a>. About 18% of individuals who present with an acute aortic dissection have a history of open-heart surgery. Individuals who have undergone aortic valve replacement for <a href="/wiki/Aortic_insufficiency" class="mw-redirect" title="Aortic insufficiency">aortic insufficiency</a> are at particularly high risk because aortic regurgitation causes increased blood flow in the ascending aorta. This can cause dilatation and weakening of the walls of the ascending aorta.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p><a href="/wiki/Syphilis" title="Syphilis">Syphilis</a> only potentially causes aortic dissection in its tertiary stage.<sup id="cite_ref-Kamalakannan2007_24-0" class="reference"><a href="#cite_note-Kamalakannan2007-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=7" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:AoDissect_Schema_01a.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/28/AoDissect_Schema_01a.png/220px-AoDissect_Schema_01a.png" decoding="async" width="220" height="180" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/28/AoDissect_Schema_01a.png/330px-AoDissect_Schema_01a.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/28/AoDissect_Schema_01a.png/440px-AoDissect_Schema_01a.png 2x" data-file-width="610" data-file-height="500" /></a><figcaption>Blood penetrates the intima and enters the media layer.</figcaption></figure> <p>As with all other arteries, the aorta is made up of three layers, the <a href="/wiki/Tunica_intima" title="Tunica intima">intima</a>, the <a href="/wiki/Tunica_media" title="Tunica media">media</a>, and the <a href="/wiki/Tunica_adventitia" class="mw-redirect" title="Tunica adventitia">adventitia</a>. The intima is in direct contact with the blood inside the vessel, and mainly consists of a layer of <a href="/wiki/Endothelium" title="Endothelium">endothelial cells</a> on a <a href="/wiki/Basement_membrane" title="Basement membrane">basement membrane</a>; the media contains connective and muscle tissue, and the vessel is protected on the outside by the adventitia, comprising connective tissue.<sup id="cite_ref-Hiratzka2010_25-0" class="reference"><a href="#cite_note-Hiratzka2010-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p><p>In an aortic dissection, blood penetrates the intima and enters the media layer. The high pressure rips the <a href="/wiki/Biological_tissue" class="mw-redirect" title="Biological tissue">tissue</a> of the media apart along the laminated plane splitting the inner two-thirds and the outer one-third of the media apart.<sup id="cite_ref-Seidensticker2008_26-0" class="reference"><a href="#cite_note-Seidensticker2008-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> This can propagate along the length of the aorta for a variable distance forward or backward. Dissections that propagate towards the iliac bifurcation (with the flow of blood) are called anterograde dissections and those that propagate towards the aortic root (opposite of the flow of blood) are called retrograde dissections. The initial tear is usually within 100 mm of the <a href="/wiki/Aortic_valve" title="Aortic valve">aortic valve</a>, so a retrograde dissection can easily compromise the pericardium leading to a hemopericardium. Anterograde dissections may propagate all the way to the iliac bifurcation of the aorta, rupture the aortic wall, or recanalize into the intravascular lumen leading to a double-barrel aorta. The double-barrel aorta relieves the pressure of blood flow and reduces the risk of rupture. Rupture leads to hemorrhaging into a body cavity, and prognosis depends on the area of rupture. Retroperitoneal and pericardial ruptures are both possible.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Aortic_dissection_(1)_Victoria_blue-HE.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/94/Aortic_dissection_%281%29_Victoria_blue-HE.jpg/220px-Aortic_dissection_%281%29_Victoria_blue-HE.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/94/Aortic_dissection_%281%29_Victoria_blue-HE.jpg/330px-Aortic_dissection_%281%29_Victoria_blue-HE.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/94/Aortic_dissection_%281%29_Victoria_blue-HE.jpg/440px-Aortic_dissection_%281%29_Victoria_blue-HE.jpg 2x" data-file-width="500" data-file-height="376" /></a><figcaption>Histopathological image of dissecting aneurysm of the thoracic aorta in a patient without evidence of Marfan syndrome: The damaged aorta was surgically removed and replaced by artificial vessel, Victoria blue and HE stain.</figcaption></figure> <p>The initiating event in aortic dissection is a tear in the intimal lining of the aorta. Due to the high pressures in the aorta, blood enters the media at the point of the tear. The force of the blood entering the media causes the tear to extend. It may extend proximally (closer to the heart) or distally (away from the heart) or both. The blood travels through the media, creating a <a href="/wiki/Pseudoaneurysm" title="Pseudoaneurysm">false lumen</a> (the true lumen is the normal conduit of blood in the aorta). Separating the false lumen from the true lumen is a layer of intimal tissue known as the intimal flap.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>The vast majority of aortic dissections originate with an intimal tear in either the <a href="/wiki/Ascending_aorta" title="Ascending aorta">ascending aorta</a> (65%), the <a href="/wiki/Aortic_arch" title="Aortic arch">aortic arch</a> (10%), or just distal to the <a href="/wiki/Ligamentum_arteriosum" title="Ligamentum arteriosum">ligamentum arteriosum</a> in the <a href="/wiki/Descending_aorta" title="Descending aorta">descending thoracic aorta</a> (20%).<sup class="noprint Inline-Template" style="margin-left:0.1em; white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Please_clarify" title="Wikipedia:Please clarify"><span title="The text near this tag may need clarification or removal of jargon. (April 2018)">clarification needed</span></a></i>]</sup> </p><p>As blood flows down the false lumen, it may cause secondary tears in the intima. Through these secondary tears, the blood can re-enter the true lumen.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>While it is not always clear why an intimal tear may occur, quite often it involves degeneration of the <a href="/wiki/Collagen" title="Collagen">collagen</a> and <a href="/wiki/Elastin" title="Elastin">elastin</a> that make up the media. This is known as <a href="/wiki/Cystic_medial_necrosis" class="mw-redirect" title="Cystic medial necrosis">cystic medial necrosis</a> and is most commonly associated with Marfan syndrome and is also associated with Ehlers-Danlos syndrome.<sup id="cite_ref-omim.org_28-0" class="reference"><a href="#cite_note-omim.org-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Elsevier_Health_Sciences_29-0" class="reference"><a href="#cite_note-Elsevier_Health_Sciences-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p><p>In about 13% of aortic dissections, no evidence of an intimal tear is found. In these cases, the inciting event is thought to be an intramural <a href="/wiki/Hematoma" title="Hematoma">hematoma</a> (caused by bleeding within the media). Since no direct connection exists between the true lumen and the false lumen in these cases, diagnosing an aortic dissection by <a href="#Aortogram">aortography</a> is difficult if the cause is an intramural hematoma. An aortic dissection secondary to an intramural hematoma should be treated the same as one caused by an intimal tear.<sup id="cite_ref-omim.org_28-1" class="reference"><a href="#cite_note-omim.org-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Elsevier_Health_Sciences_29-1" class="reference"><a href="#cite_note-Elsevier_Health_Sciences-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=8" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Because of the varying symptoms of aortic dissection, the diagnosis is sometimes difficult to make. Concern should be increased in those with low blood pressure, neurological problems, and an unequal pulses.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p><p>While taking a good history from the individual may be strongly suggestive of an aortic dissection, the diagnosis cannot always be made by history and physical signs alone. Often, the diagnosis is made by visualization of the intimal flap on a diagnostic imaging test. Common tests used to diagnose an aortic dissection include a <a href="/wiki/CT_scan" title="CT scan">CT scan</a> of the chest with iodinated contrast material and a <a href="/wiki/Transesophageal_echocardiogram" title="Transesophageal echocardiogram">transesophageal echocardiogram</a>. The proximity of the aorta to the <a href="/wiki/Esophagus" title="Esophagus">esophagus</a> allows the use of <a href="/wiki/High-frequency_ultrasound" class="mw-redirect" title="High-frequency ultrasound">higher-frequency ultrasound</a> for better anatomical images. Other tests that may be used include an aortogram or magnetic resonance angiogram of the aorta. Each of these tests has pros and cons, and they do not have equal sensitivities and specificities in the diagnosis of aortic dissection.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>In general, the imaging technique chosen is based on the pretest likelihood of the diagnosis, availability of the testing modality, patient stability, and the sensitivity and specificity of the test.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="D-dimer">D-dimer</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=9" title="Edit section: D-dimer"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A measurement of blood <a href="/wiki/D-dimer" title="D-dimer">D-dimer</a> level may be useful in diagnostic evaluation. A level less than 500 ng/ml may be considered evidence against a diagnosis of aortic dissection,<sup id="cite_ref-Lancet2016_1-18" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Shimony2011_31-0" class="reference"><a href="#cite_note-Shimony2011-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> although this guideline is only applicable in cases deemed "low risk"<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> and within 24 hours of symptom onset.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/American_Heart_Association" title="American Heart Association">American Heart Association</a> does not advise using this test in making the diagnosis, as evidence is still tentative.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Chest_X-ray">Chest X-ray</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=10" title="Edit section: Chest X-ray"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:AoDiss_ChestXRay.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/31/AoDiss_ChestXRay.jpg/220px-AoDiss_ChestXRay.jpg" decoding="async" width="220" height="169" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/31/AoDiss_ChestXRay.jpg/330px-AoDiss_ChestXRay.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/31/AoDiss_ChestXRay.jpg/440px-AoDiss_ChestXRay.jpg 2x" data-file-width="2052" data-file-height="1575" /></a><figcaption>Aortic dissection on CXR: Note is made of a wide <a href="/wiki/Aortic_knob" class="mw-redirect" title="Aortic knob">aortic knob</a>.</figcaption></figure> <p><a href="/wiki/Chest_radiograph" title="Chest radiograph">Chest radiography</a> may although demonstrate a change in the morphology of the thoracic aorta which can be seen in aortic dissection. Classically, new widening of the <a href="/wiki/Mediastinum" title="Mediastinum">mediastinum</a> on radiograph is of moderate <a href="/wiki/Sensitivity_(tests)" class="mw-redirect" title="Sensitivity (tests)">sensitivity</a> for detecting an ascending aortic dissection; however, this finding is of low <a href="/wiki/Specificity_(tests)" class="mw-redirect" title="Specificity (tests)">specificity</a>, as many other conditions can cause apparent widening of the mediastinum.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>There are several other associated radiographic findings:<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <ul><li>The "calcium sign" describes an apparent separation of the intimal calcification from the outer aortic margin by greater than 10 mm.</li> <li><a href="/wiki/Pleural_effusion" title="Pleural effusion">Pleural effusions</a>, more commonly in descending aortic dissections, and typically left-sided.</li> <li>Other: the obliteration of the <a href="/wiki/Aortic_knob" class="mw-redirect" title="Aortic knob">aortic knob</a>, depression of the left mainstem bronchus, loss of the paratracheal stripe, and tracheal deviation.</li></ul> <p>Importantly, about 12 to 20% of aortic dissections are not detectable by chest radiograph; therefore, a "normal" chest radiograph does not rule out aortic dissection. If there is high clinical suspicion, a more sensitive imaging test (<a href="/wiki/Computed_tomography_angiography" title="Computed tomography angiography">CT angiogram</a>, <a href="/wiki/Magnetic_resonance_angiography" title="Magnetic resonance angiography">MR angiography</a>, or <a href="/wiki/Transesophageal_echocardiogram" title="Transesophageal echocardiogram">transesophageal echo</a>) may be warranted.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Computed_tomography">Computed tomography</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=11" title="Edit section: Computed tomography"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Computed_tomography_angiography" title="Computed tomography angiography">Computed tomography angiography</a> is a fast, non-invasive test that gives an accurate three-dimensional view of the aorta. These images are produced by taking rapid, thin-cut slices of the chest and abdomen, and combining them in the computer to create cross-sectional slices. To delineate the aorta to the accuracy necessary to make the proper diagnosis, an iodinated contrast material is injected into a peripheral vein. Contrast is injected and the scan performed using a <a href="/wiki/Bolus_tracking" class="mw-redirect" title="Bolus tracking">bolus tracking</a> method. This type of scan is timed to injection to capture the contrast as it enters the aorta. The scan then follows the contrast as it flows through the vessel. It has a sensitivity of 96 to 100% and a specificity of 96 to 100%. Disadvantages include the need for iodinated contrast material and the inability to diagnose the site of the intimal tear.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <ul class="gallery mw-gallery-traditional"> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><a href="/wiki/File:DissectionCT.png" class="mw-file-description" title="CT with contrast demonstrating aneurysmal dilation and a dissection of the ascending aorta (type A Stanford)"><img alt="CT with contrast demonstrating aneurysmal dilation and a dissection of the ascending aorta (type A Stanford)" src="//upload.wikimedia.org/wikipedia/commons/thumb/1/12/DissectionCT.png/120px-DissectionCT.png" decoding="async" width="120" height="102" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/12/DissectionCT.png/180px-DissectionCT.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/12/DissectionCT.png/240px-DissectionCT.png 2x" data-file-width="1030" data-file-height="875" /></a></span></div> <div class="gallerytext">CT with contrast demonstrating aneurysmal dilation and a dissection of the ascending aorta (type A Stanford)</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><a href="/wiki/File:Descending_(Type_B_Stanford)_Aortic_Dissection.PNG" class="mw-file-description" title="Chest CT with descending (type B Stanford) aortic dissection (red circle)"><img alt="Chest CT with descending (type B Stanford) aortic dissection (red circle)" src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0a/Descending_%28Type_B_Stanford%29_Aortic_Dissection.PNG/120px-Descending_%28Type_B_Stanford%29_Aortic_Dissection.PNG" decoding="async" width="120" height="45" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0a/Descending_%28Type_B_Stanford%29_Aortic_Dissection.PNG/180px-Descending_%28Type_B_Stanford%29_Aortic_Dissection.PNG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0a/Descending_%28Type_B_Stanford%29_Aortic_Dissection.PNG/240px-Descending_%28Type_B_Stanford%29_Aortic_Dissection.PNG 2x" data-file-width="1947" data-file-height="734" /></a></span></div> <div class="gallerytext">Chest CT with descending (type B Stanford) aortic dissection (red circle)</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><a href="/wiki/File:Dissection2018WithPericardial.jpg" class="mw-file-description" title="Type A dissection with pericardial effusion as a result."><img alt="Type A dissection with pericardial effusion as a result." src="//upload.wikimedia.org/wikipedia/commons/thumb/9/90/Dissection2018WithPericardial.jpg/120px-Dissection2018WithPericardial.jpg" decoding="async" width="120" height="86" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/90/Dissection2018WithPericardial.jpg/180px-Dissection2018WithPericardial.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/90/Dissection2018WithPericardial.jpg/240px-Dissection2018WithPericardial.jpg 2x" data-file-width="990" data-file-height="713" /></a></span></div> <div class="gallerytext">Type A dissection with pericardial effusion as a result.</div> </li> </ul> <div class="mw-heading mw-heading3"><h3 id="MRI">MRI</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=12" title="Edit section: MRI"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:AoDiss_MRT.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/85/AoDiss_MRT.jpg/220px-AoDiss_MRT.jpg" decoding="async" width="220" height="271" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/85/AoDiss_MRT.jpg/330px-AoDiss_MRT.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/8/85/AoDiss_MRT.jpg 2x" data-file-width="416" data-file-height="512" /></a><figcaption><a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">MRI</a> of an aortic dissection <div><ol><li>Aorta descendens with dissection</li><li>Aorta isthmus</li></ol></div></figcaption></figure> <p><a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">Magnetic resonance imaging</a> (MRI) is also used for the detection and assessment of aortic dissection, with a sensitivity of 98% and a specificity of 98%. An MRI examination of the aorta produces a three-dimensional reconstruction of the aorta, allowing the physician to determine the location of the intimal tear and the involvement of branch vessels, and to locate any secondary tears. It is a noninvasive test, does not require the use of iodinated contrast material, and can detect and quantitate the degree of aortic insufficiency.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>The disadvantage of the MRI scan in the face of aortic dissection is that it may be available only in larger hospitals, and the scan is relatively time-consuming, which could be dangerous in people who are already very unwell. Due to the high-intensity magnetic fields used during MRI, it cannot be used on individuals with metallic implants. In addition, some individuals experience <a href="/wiki/Claustrophobia" title="Claustrophobia">claustrophobia</a> while surrounded by the MRI magnet.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Ultrasound">Ultrasound</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=13" title="Edit section: Ultrasound"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1237032888/mw-parser-output/.tmulti">.mw-parser-output .tmulti .multiimageinner{display:flex;flex-direction:column}.mw-parser-output .tmulti .trow{display:flex;flex-direction:row;clear:left;flex-wrap:wrap;width:100%;box-sizing:border-box}.mw-parser-output .tmulti .tsingle{margin:1px;float:left}.mw-parser-output .tmulti .theader{clear:both;font-weight:bold;text-align:center;align-self:center;background-color:transparent;width:100%}.mw-parser-output .tmulti .thumbcaption{background-color:transparent}.mw-parser-output .tmulti .text-align-left{text-align:left}.mw-parser-output .tmulti .text-align-right{text-align:right}.mw-parser-output .tmulti .text-align-center{text-align:center}@media all and (max-width:720px){.mw-parser-output .tmulti .thumbinner{width:100%!important;box-sizing:border-box;max-width:none!important;align-items:center}.mw-parser-output .tmulti .trow{justify-content:center}.mw-parser-output .tmulti .tsingle{float:none!important;max-width:100%!important;box-sizing:border-box;text-align:center}.mw-parser-output .tmulti .tsingle .thumbcaption{text-align:left}.mw-parser-output .tmulti .trow>.thumbcaption{text-align:center}}@media screen{html.skin-theme-clientpref-night .mw-parser-output .tmulti .multiimageinner img{background-color:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .tmulti .multiimageinner img{background-color:white}}</style><div class="thumb tmulti tright"><div class="thumbinner multiimageinner" style="width:408px;max-width:408px"><div class="trow"><div class="tsingle" style="width:202px;max-width:202px"><div class="thumbimage"><span typeof="mw:File"><a href="/wiki/File:Aortic_dissection_-_Echocardiogram_-_Longitudinal_view.jpg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a2/Aortic_dissection_-_Echocardiogram_-_Longitudinal_view.jpg/200px-Aortic_dissection_-_Echocardiogram_-_Longitudinal_view.jpg" decoding="async" width="200" height="142" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a2/Aortic_dissection_-_Echocardiogram_-_Longitudinal_view.jpg/300px-Aortic_dissection_-_Echocardiogram_-_Longitudinal_view.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a2/Aortic_dissection_-_Echocardiogram_-_Longitudinal_view.jpg/400px-Aortic_dissection_-_Echocardiogram_-_Longitudinal_view.jpg 2x" data-file-width="848" data-file-height="602" /></a></span></div></div><div class="tsingle" style="width:202px;max-width:202px"><div class="thumbimage"><span typeof="mw:File"><a href="/wiki/File:Aortic_dissection_-_Echocardiogram_-_Longitudinal_view_-_Color.jpg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/3/32/Aortic_dissection_-_Echocardiogram_-_Longitudinal_view_-_Color.jpg/200px-Aortic_dissection_-_Echocardiogram_-_Longitudinal_view_-_Color.jpg" decoding="async" width="200" height="142" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/32/Aortic_dissection_-_Echocardiogram_-_Longitudinal_view_-_Color.jpg/300px-Aortic_dissection_-_Echocardiogram_-_Longitudinal_view_-_Color.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/32/Aortic_dissection_-_Echocardiogram_-_Longitudinal_view_-_Color.jpg/400px-Aortic_dissection_-_Echocardiogram_-_Longitudinal_view_-_Color.jpg 2x" data-file-width="848" data-file-height="603" /></a></span></div></div></div><div class="trow" style="display:flex"><div class="thumbcaption">An <a href="/wiki/Echocardiogram" class="mw-redirect" title="Echocardiogram">echocardiogram</a> displaying the true <a href="/wiki/Lumen_(anatomy)" title="Lumen (anatomy)">lumen</a> and false lumen of an aortic dissection: In the image to the left, the intimal flap can be seen separating the two lumens. In the image to the right, color flow during ventricular <a href="/wiki/Systole_(medicine)" class="mw-redirect" title="Systole (medicine)">systole</a> suggests that the upper lumen is the true lumen.</div></div></div></div> <p>The <a href="/wiki/Transesophageal_echocardiogram" title="Transesophageal echocardiogram">transesophageal echocardiogram</a> (TEE) is a good test in the diagnosis of aortic dissection, with a sensitivity up to 98% and a specificity up to 97%. It has become the preferred imaging modality for suspected aortic dissection. It is a relatively noninvasive test, requiring the individual to swallow the echocardiography probe. It is especially good in the evaluation of AI in the setting of ascending aortic dissection and to determine whether the ostia (origins) of the coronary arteries are involved. While many institutions give sedation during transesophageal echocardiography for added patient comfort, it can be performed in cooperative individuals without the use of sedation. Disadvantages of TEE include the inability to visualize the distal ascending aorta (the beginning of the <a href="/wiki/Aortic_arch" title="Aortic arch">aortic arch</a>), and the descending abdominal aorta that lies below the <a href="/wiki/Stomach" title="Stomach">stomach</a>. A TEE may be technically difficult to perform in individuals with esophageal strictures or <a href="/wiki/Esophageal_varices" title="Esophageal varices">varices</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <ul class="gallery mw-gallery-traditional"> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><span><video id="mwe_player_0" poster="//upload.wikimedia.org/wikipedia/commons/thumb/f/f5/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm/120px--Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm.jpg" controls="" preload="none" data-mw-tmh="" class="mw-file-element" width="120" height="89" data-durationhint="1" data-mwtitle="Aortic_dissection_E00249_(CardioNetworks_ECHOpedia).webm" data-mwprovider="wikimediacommons"><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/f/f5/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm.480p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="480p.vp9.webm" data-width="648" data-height="480" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/f/f5/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm.144p.mjpeg.mov" type="video/quicktime" data-transcodekey="144p.mjpeg.mov" data-width="194" data-height="144" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/f/f5/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm.240p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="240p.vp9.webm" data-width="324" data-height="240" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/f/f5/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm.360p.webm" type="video/webm; codecs="vp8, vorbis"" data-transcodekey="360p.webm" data-width="486" data-height="360" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/f/f5/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm.360p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="360p.vp9.webm" data-width="486" data-height="360" /><source src="//upload.wikimedia.org/wikipedia/commons/f/f5/Aortic_dissection_E00249_%28CardioNetworks_ECHOpedia%29.webm" type="video/webm; codecs="vp8"" data-width="647" data-height="480" /></video></span></span></div> <div class="gallerytext">Aortic dissection with an intramural hematoma as seen on TEE</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><span><video id="mwe_player_1" poster="//upload.wikimedia.org/wikipedia/commons/thumb/b/ba/UOTW_17_-_Ultrasound_of_the_Week_1.webm/120px--UOTW_17_-_Ultrasound_of_the_Week_1.webm.jpg" controls="" preload="none" data-mw-tmh="" class="mw-file-element" width="120" height="71" data-durationhint="10" data-mwtitle="UOTW_17_-_Ultrasound_of_the_Week_1.webm" data-mwprovider="wikimediacommons"><source src="//upload.wikimedia.org/wikipedia/commons/b/ba/UOTW_17_-_Ultrasound_of_the_Week_1.webm" type="video/webm; codecs="vp8"" data-width="792" data-height="470" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/b/ba/UOTW_17_-_Ultrasound_of_the_Week_1.webm/UOTW_17_-_Ultrasound_of_the_Week_1.webm.240p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="240p.vp9.webm" data-width="404" data-height="240" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/b/ba/UOTW_17_-_Ultrasound_of_the_Week_1.webm/UOTW_17_-_Ultrasound_of_the_Week_1.webm.360p.webm" type="video/webm; codecs="vp8, vorbis"" data-transcodekey="360p.webm" data-width="606" data-height="360" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/b/ba/UOTW_17_-_Ultrasound_of_the_Week_1.webm/UOTW_17_-_Ultrasound_of_the_Week_1.webm.360p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="360p.vp9.webm" data-width="606" data-height="360" /></video></span></span></div> <div class="gallerytext">Type A aortic dissection<sup id="cite_ref-UOTW17_35-0" class="reference"><a href="#cite_note-UOTW17-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup></div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><span><video id="mwe_player_2" poster="//upload.wikimedia.org/wikipedia/commons/thumb/1/10/UOTW_17_-_Ultrasound_of_the_Week_2.webm/120px--UOTW_17_-_Ultrasound_of_the_Week_2.webm.jpg" controls="" preload="none" data-mw-tmh="" class="mw-file-element" width="120" height="71" data-durationhint="4" data-mwtitle="UOTW_17_-_Ultrasound_of_the_Week_2.webm" data-mwprovider="wikimediacommons"><source src="//upload.wikimedia.org/wikipedia/commons/1/10/UOTW_17_-_Ultrasound_of_the_Week_2.webm" type="video/webm; codecs="vp8"" data-width="792" data-height="470" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/1/10/UOTW_17_-_Ultrasound_of_the_Week_2.webm/UOTW_17_-_Ultrasound_of_the_Week_2.webm.240p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="240p.vp9.webm" data-width="404" data-height="240" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/1/10/UOTW_17_-_Ultrasound_of_the_Week_2.webm/UOTW_17_-_Ultrasound_of_the_Week_2.webm.360p.webm" type="video/webm; codecs="vp8, vorbis"" data-transcodekey="360p.webm" data-width="606" data-height="360" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/1/10/UOTW_17_-_Ultrasound_of_the_Week_2.webm/UOTW_17_-_Ultrasound_of_the_Week_2.webm.360p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="360p.vp9.webm" data-width="606" data-height="360" /></video></span></span></div> <div class="gallerytext">Type A aortic dissection<sup id="cite_ref-UOTW17_35-1" class="reference"><a href="#cite_note-UOTW17-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup></div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><span><video id="mwe_player_3" poster="//upload.wikimedia.org/wikipedia/commons/thumb/e/e2/UOTW_55_-_Ultrasound_of_the_Week_4.webm/120px--UOTW_55_-_Ultrasound_of_the_Week_4.webm.jpg" controls="" preload="none" data-mw-tmh="" class="mw-file-element" width="120" height="79" data-durationhint="4" data-mwtitle="UOTW_55_-_Ultrasound_of_the_Week_4.webm" data-mwprovider="wikimediacommons"><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/e/e2/UOTW_55_-_Ultrasound_of_the_Week_4.webm/UOTW_55_-_Ultrasound_of_the_Week_4.webm.480p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="480p.vp9.webm" data-width="732" data-height="480" /><source src="//upload.wikimedia.org/wikipedia/commons/e/e2/UOTW_55_-_Ultrasound_of_the_Week_4.webm" type="video/webm; codecs="vp8, vorbis"" data-width="792" data-height="520" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/e/e2/UOTW_55_-_Ultrasound_of_the_Week_4.webm/UOTW_55_-_Ultrasound_of_the_Week_4.webm.240p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="240p.vp9.webm" data-width="366" data-height="240" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/e/e2/UOTW_55_-_Ultrasound_of_the_Week_4.webm/UOTW_55_-_Ultrasound_of_the_Week_4.webm.360p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="360p.vp9.webm" data-width="548" data-height="360" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/e/e2/UOTW_55_-_Ultrasound_of_the_Week_4.webm/UOTW_55_-_Ultrasound_of_the_Week_4.webm.360p.webm" type="video/webm; codecs="vp8, vorbis"" data-transcodekey="360p.webm" data-width="548" data-height="360" /></video></span></span></div> <div class="gallerytext">Dissection of both the thoracic and abdominal aorta<sup id="cite_ref-UOTW55_36-0" class="reference"><a href="#cite_note-UOTW55-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup></div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><span><video id="mwe_player_4" poster="//upload.wikimedia.org/wikipedia/commons/thumb/b/b4/UOTW_55_-_Ultrasound_of_the_Week_3.webm/120px--UOTW_55_-_Ultrasound_of_the_Week_3.webm.jpg" controls="" preload="none" data-mw-tmh="" class="mw-file-element" width="120" height="79" data-durationhint="4" data-mwtitle="UOTW_55_-_Ultrasound_of_the_Week_3.webm" data-mwprovider="wikimediacommons"><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/b/b4/UOTW_55_-_Ultrasound_of_the_Week_3.webm/UOTW_55_-_Ultrasound_of_the_Week_3.webm.480p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="480p.vp9.webm" data-width="732" data-height="480" /><source src="//upload.wikimedia.org/wikipedia/commons/b/b4/UOTW_55_-_Ultrasound_of_the_Week_3.webm" type="video/webm; codecs="vp8, vorbis"" data-width="792" data-height="520" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/b/b4/UOTW_55_-_Ultrasound_of_the_Week_3.webm/UOTW_55_-_Ultrasound_of_the_Week_3.webm.240p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="240p.vp9.webm" data-width="366" data-height="240" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/b/b4/UOTW_55_-_Ultrasound_of_the_Week_3.webm/UOTW_55_-_Ultrasound_of_the_Week_3.webm.360p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="360p.vp9.webm" data-width="548" data-height="360" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/b/b4/UOTW_55_-_Ultrasound_of_the_Week_3.webm/UOTW_55_-_Ultrasound_of_the_Week_3.webm.360p.webm" type="video/webm; codecs="vp8, vorbis"" data-transcodekey="360p.webm" data-width="548" data-height="360" /></video></span></span></div> <div class="gallerytext">Dissection of both the thoracic and abdominal aorta<sup id="cite_ref-UOTW55_36-1" class="reference"><a href="#cite_note-UOTW55-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup></div> </li> </ul> <div class="mw-heading mw-heading3"><h3 id="Aortogram">Aortogram</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=14" title="Edit section: Aortogram"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Aortography" title="Aortography">Aortography</a></div> <p>An aortogram involves the placement of a catheter in the aorta and injection of contrast material while taking X-rays of the aorta. The procedure is known as <a href="/wiki/Aortography" title="Aortography">aortography</a>. Previously thought to be the diagnostic <a href="/wiki/Gold_standard_(test)" title="Gold standard (test)">gold standard</a>, it has been supplanted by other, less-invasive imaging modalities.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Classification">Classification</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=15" title="Edit section: Classification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <table class="wikitable" style="text-align: center"> <caption>Classification of aortic dissection </caption> <tbody><tr> <td> </td> <td><span typeof="mw:File"><a href="/wiki/File:Aortic_dissection_of_DeBakey_type_I.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2c/Aortic_dissection_of_DeBakey_type_I.png/100px-Aortic_dissection_of_DeBakey_type_I.png" decoding="async" width="100" height="314" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/2/2c/Aortic_dissection_of_DeBakey_type_I.png 1.5x" data-file-width="142" data-file-height="446" /></a></span> </td> <td><span typeof="mw:File"><a href="/wiki/File:Aortic_dissection_of_DeBakey_type_II.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7f/Aortic_dissection_of_DeBakey_type_II.png/90px-Aortic_dissection_of_DeBakey_type_II.png" decoding="async" width="90" height="192" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7f/Aortic_dissection_of_DeBakey_type_II.png/135px-Aortic_dissection_of_DeBakey_type_II.png 1.5x, //upload.wikimedia.org/wikipedia/commons/7/7f/Aortic_dissection_of_DeBakey_type_II.png 2x" data-file-width="138" data-file-height="295" /></a></span> </td> <td><span typeof="mw:File"><a href="/wiki/File:Aortic_dissection_of_DeBakey_type_III.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/59/Aortic_dissection_of_DeBakey_type_III.png/130px-Aortic_dissection_of_DeBakey_type_III.png" decoding="async" width="130" height="292" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/59/Aortic_dissection_of_DeBakey_type_III.png/195px-Aortic_dissection_of_DeBakey_type_III.png 1.5x, //upload.wikimedia.org/wikipedia/commons/5/59/Aortic_dissection_of_DeBakey_type_III.png 2x" data-file-width="197" data-file-height="443" /></a></span> </td></tr> <tr style="background:#dcdcdc;"> <td style="text-align: left">Percentage </td> <td>60% </td> <td>10–15% </td> <td>25–30% </td></tr> <tr> <td style="text-align: left">Type </td> <td>DeBakey I </td> <td>DeBakey II </td> <td>DeBakey III </td></tr> <tr> <td> </td> <td colspan="2">Stanford A (proximal) </td> <td>Stanford B (distal) </td></tr></tbody></table> <p>Several different classification systems have been used to describe aortic dissections. One such classification is based on chronicity and labels aortic dissections as hyperacute (<24 hours duration), acute (2–7 days), subacute (8–30 days), and chronic (>30 days).<sup id="cite_ref-Lech2017_20-2" class="reference"><a href="#cite_note-Lech2017-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> The systems commonly in use are based on either the anatomy of the dissection or the duration of onset of symptoms before the presentation. The Stanford system is used more commonly now, as it is more attuned to the management of the patient.<sup id="cite_ref-FOOTNOTEDemersMiller20161216_37-0" class="reference"><a href="#cite_note-FOOTNOTEDemersMiller20161216-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="DeBakey">DeBakey</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=16" title="Edit section: DeBakey"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The DeBakey system, named after cardiothoracic surgeon <a href="/wiki/Michael_E._DeBakey" class="mw-redirect" title="Michael E. DeBakey">Michael E. DeBakey</a>, is an anatomical description of the aortic dissection. It categorizes the dissection based on where the original intimal tear is located and the extent of the dissection (localized to either the ascending aorta or descending aorta or involving both the ascending and descending aorta).<sup id="cite_ref-DeBakey1965_38-0" class="reference"><a href="#cite_note-DeBakey1965-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p> <ul><li><b>Type I</b> – originates in ascending aorta, and propagates at least to the aortic arch and often beyond it distally. It is most often seen in patients less than 65 years of age and is the most lethal form of the disease.</li> <li><b>Type II</b> – originates in the ascending aorta and is confined to it.</li> <li><b>Type III</b> – originates in the descending aorta and rarely extends proximally, but will extend distally. It most often occurs in elderly patients with <a href="/wiki/Atherosclerosis" title="Atherosclerosis">atherosclerosis</a> and hypertension.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Stanford">Stanford</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=17" title="Edit section: Stanford"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Stanford classification is divided into two groups, A and B, depending on whether the ascending aorta is involved.<sup id="cite_ref-Daily1970_39-0" class="reference"><a href="#cite_note-Daily1970-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p> <ul><li><b>A</b> – involves the ascending aorta and/or aortic arch, and possibly the descending aorta. The tear can originate in the ascending aorta, the aortic arch, or more rarely, in the descending aorta. It includes DeBakey types I and II.</li> <li><b>B</b> – involves the descending aorta or the arch (distal to the left subclavian artery), without the involvement of the ascending aorta. It includes DeBakey type III.</li></ul> <p>The Stanford classification is useful as it follows clinical practice, as type A ascending aortic dissections generally require primary surgical treatment, whereas type B dissections generally are treated medically as initial treatment with surgery reserved for any complications.<sup id="cite_ref-Aortic_Dissection_40-0" class="reference"><a href="#cite_note-Aortic_Dissection-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p>The main indication for surgical repair of type A dissections is the prevention of acute hemorrhagic pericardial tamponade due to leakage of blood through the dissected layers of the intrapericardial proximal aorta. A secondary indication is acute aortic valve insufficiency (regurgitation): ascending aortic dissections often involve the aortic valve, which, having lost its suspensory support, telescopes down into the aortic root, resulting in aortic incompetence. The valve must be resuspended to be reseated, as well as to repair or prevent coronary artery injury. Also, the area of dissection is removed and replaced with a Dacron graft to prevent further dissection from occurring. However, type B dissections are not improved, from a mortality point of view, by the operation, unless leaking, rupture, or compromise to other organs, e.g. kidneys, occurs.<sup id="cite_ref-Aortic_Dissection_40-1" class="reference"><a href="#cite_note-Aortic_Dissection-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=18" title="Edit section: Prevention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Among the recognized risk factors for aortic dissection, hypertension, <a href="/wiki/Dyslipidemia" title="Dyslipidemia">abnormally high levels of lipids (such as cholesterol) in the blood</a>, and smoking tobacco are considered preventable risk factors.<sup id="cite_ref-Lancet2016_1-19" class="reference"><a href="#cite_note-Lancet2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Repair of an enlargement of the ascending aorta from an aneurysm or previously unrecognized and untreated aortic dissections is recommended when greater than 5.5 cm (2.2 in) in size to decrease the risk of dissection. Repair may be recommended when greater than 4.5 cm (1.8 in) in size if the person has one of the several connective-tissue disorders or a family history of a ruptured aorta.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=19" title="Edit section: Management"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In an acute dissection, treatment choice depends on its location. For Stanford type A (ascending aortic) dissection, surgical management is superior to medical management.<sup id="cite_ref-ReferenceA_4-1" class="reference"><a href="#cite_note-ReferenceA-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> For uncomplicated Stanford type B (distal aortic) dissections (including abdominal aortic dissections), medical management is preferred over surgery.<sup id="cite_ref-:0_42-0" class="reference"><a href="#cite_note-:0-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> Complicated Stanford type B aortic dissections require surgical intervention after initiation of medical therapy, with endovascular stent-grafting (TEVAR) available as a less invasive alternative to surgery.<sup id="cite_ref-:0_42-1" class="reference"><a href="#cite_note-:0-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p><p>The risk of death due to aortic dissection is highest in the first few hours after the dissection begins, and decreases afterward.<sup id="cite_ref-:0_42-2" class="reference"><a href="#cite_note-:0-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> Because of this, the therapeutic strategies differ for the treatment of an acute dissection compared to a chronic dissection. An acute dissection is one in which the individual presents within the first two weeks. If the individual has managed to survive this window period, their prognosis is improved.<sup id="cite_ref-:0_42-3" class="reference"><a href="#cite_note-:0-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> About 66% of all dissections present in the acute phase. Individuals who present two weeks after the onset of the dissection are said to have chronic aortic dissections.<sup id="cite_ref-:0_42-4" class="reference"><a href="#cite_note-:0-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> These individuals have been self-selected as survivors of the acute episode and can be treated with medical therapy as long as they are stable.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medication">Medication</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=20" title="Edit section: Medication"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Aortic dissection generally presents as a hypertensive emergency, and the prime consideration of medical management is to decrease the <a href="/wiki/Shear_force" title="Shear force">shear stress</a> in the aortic wall (dP/dt (force of ejection of blood from the <a href="/wiki/Left_ventricle" class="mw-redirect" title="Left ventricle">left ventricle</a>)) by decreasing blood pressure and the heart rate. The target blood pressure should be a <a href="/wiki/Mean_arterial_pressure" title="Mean arterial pressure">mean arterial pressure</a> (MAP) of 60 to 75 <a href="/wiki/MmHg" class="mw-redirect" title="MmHg">mmHg</a>, or the lowest blood pressure tolerated. Initial decreases should be by about 20%.<sup id="cite_ref-White2013_2-12" class="reference"><a href="#cite_note-White2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The target heart rate is less than 65 beats per minute. Long-term blood pressure control is required for every person who has experienced aortic dissection.<sup id="cite_ref-:0_42-5" class="reference"><a href="#cite_note-:0-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Beta_blockers" class="mw-redirect" title="Beta blockers">Beta blockers</a> are the first-line treatment for patients with acute and chronic aortic dissection. In acute dissection, fast-acting agents can be given intravenously and have doses that are easier to adjust (such as <a href="/wiki/Esmolol" title="Esmolol">esmolol</a>, <a href="/wiki/Propranolol" title="Propranolol">propranolol</a>, or <a href="/wiki/Labetalol" title="Labetalol">labetalol</a>) is preferred. Vasodilators such as <a href="/wiki/Sodium_nitroprusside" title="Sodium nitroprusside">sodium nitroprusside</a> can be considered for people with ongoing high blood pressure, but they should never be used alone, as they often stimulate a <a href="/wiki/Reflex_tachycardia" class="mw-redirect" title="Reflex tachycardia">reflexive increase in the heart rate</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p><a href="/wiki/Calcium_channel_blocker" title="Calcium channel blocker">Calcium channel blockers</a> can be used in the treatment of aortic dissection, particularly if a contraindication to the use of beta-blockers exists. The calcium channel blockers typically used are <a href="/wiki/Verapamil" title="Verapamil">verapamil</a> and <a href="/wiki/Diltiazem" title="Diltiazem">diltiazem</a>, because of their combined vasodilator and negative <a href="/wiki/Inotropic" class="mw-redirect" title="Inotropic">inotropic</a> effects.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>If the individual has refractory hypertension (persistent hypertension on the maximum doses of three different classes of antihypertensive agents), involvement of the renal arteries in the aortic dissection plane should be considered.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Surgical">Surgical</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=21" title="Edit section: Surgical"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Indications for the surgical treatment of aortic dissection include an acute proximal aortic dissection and an acute distal aortic dissection with one or more complications. Complications include compromise of a vital organ, rupture or impending rupture of the aorta, retrograde dissection into the ascending aorta. These are more common with a history of Marfan syndrome or Ehlers-Danlos syndrome.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>The objective in the surgical management of aortic dissection is to resect (remove) the most severely damaged segments of the aorta and to obliterate the entry of blood into the false lumen (both at the initial intimal tear and any secondary tears along the vessel). While excision of the intimal tear may be performed, it does not significantly change mortality.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>The particular treatment used depends on the segment or segments of the aorta involved. Some treatments are:<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <ul><li><a href="/wiki/Open_aortic_surgery" title="Open aortic surgery">Open aortic surgery</a> with replacement of the damaged section of the aorta with a tube graft (often made of <a href="/wiki/Dacron" class="mw-redirect" title="Dacron">Dacron</a>) when no damage to the <a href="/wiki/Aortic_valve" title="Aortic valve">aortic valve</a> is seen</li> <li><a href="/wiki/Bentall_procedure" title="Bentall procedure">Bentall procedure</a> – replacement of the damaged section of the aorta and replacement of the aortic valve</li> <li><a href="/wiki/David_procedure" class="mw-redirect" title="David procedure">David procedure</a> – replacement of the damaged section of the aorta and reimplantation of the aortic valve</li> <li><a href="/wiki/TEVAR" class="mw-redirect" title="TEVAR">Thoracic endovascular aortic repair</a>, a minimally invasive surgical procedure usually combined with ongoing medical management</li> <li>Frozen elephant trunk procedure (FET) is one-stage procedure for the repair of acute aortic dissection that permits concurrent total aortic arch replacement with antegrade delivery of a descending aortic stent-graft which itself functions as a proximal landing zone to facilitate prospective endovascular intervention (TEVAR) to treat residual or de novo disease in the more distal aorta.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup></li> <li>Replacement of the damaged section of the aorta with a sutureless <a href="/w/index.php?title=Vascular_ring_connector&action=edit&redlink=1" class="new" title="Vascular ring connector (page does not exist)">vascular ring connector</a>-reinforced Dacron graft: The vascular ring connector is a titanic ring used as a stent in the vascular graft to achieve a quick, blood-sealed, and sutureless anastomosis. Two furrows on the surface of the ring are for fixation of the vascular graft and the aorta. The tapes used to tie against the ring provide a larger contact surface area than the traditional stitches, thus it provides stronger anastomosis and better surgical results.</li></ul> <p>A number of comorbid conditions increase the surgical risk of repair of an aortic dissection. These conditions include the following:<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <ul><li>Prolonged preoperative evaluation (increased length of time prior to surgery)</li> <li>Advanced age</li> <li>Comorbid disease states (e.g.: <a href="/wiki/Coronary_artery_disease" title="Coronary artery disease">coronary artery disease</a>)</li> <li>Aneurysm leakage</li> <li><a href="/wiki/Cardiac_tamponade" title="Cardiac tamponade">Cardiac tamponade</a></li> <li><a href="/wiki/Shock_(circulatory)" title="Shock (circulatory)">Shock</a> - <a href="/wiki/Obstructive_shock" title="Obstructive shock">obstructive shock</a></li> <li>Past history of myocardial infarction</li> <li>History of <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a> (either acute or chronic kidney failure)</li></ul> <div class="mw-heading mw-heading3"><h3 id="Follow-up">Follow-up</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=22" title="Edit section: Follow-up"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:TypeBdisectionlumonclosed.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/06/TypeBdisectionlumonclosed.png/220px-TypeBdisectionlumonclosed.png" decoding="async" width="220" height="176" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/06/TypeBdisectionlumonclosed.png/330px-TypeBdisectionlumonclosed.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/06/TypeBdisectionlumonclosed.png/440px-TypeBdisectionlumonclosed.png 2x" data-file-width="1173" data-file-height="940" /></a><figcaption>Closure of the lumen of a Type B aortic dissection following medical management</figcaption></figure> <p>The long-term follow-up in individuals who survive aortic dissection involves strict blood pressure control. The relative risk of late rupture of an <a href="/wiki/Aortic_aneurysm" title="Aortic aneurysm">aortic aneurysm</a> is 10 times higher in individuals who have uncontrolled hypertension, compared to individuals with a systolic pressure below 130 mmHg.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>The risk of death is highest in the first two years after the acute event, and individuals should be followed closely during this time period. About 29% of late deaths following surgery are due to rupture of either a dissecting aneurysm or another aneurysm. In addition, a 17% to 25% incidence exists of new aneurysm formation, typically due to dilatation of the residual false lumen. These new aneurysms are more likely to rupture, due to their thinner walls.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p><p>Serial imaging of the aorta is suggested, with MRI being the preferred imaging technique.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=23" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <table class="wikitable"> <caption>Risk of death in untreated type A aortic dissection<sup id="cite_ref-Criado2011_3-10" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </caption> <tbody><tr> <th>Risk</th> <th>Timespan </th></tr> <tr> <td>25%</td> <td>in first 24 hours </td></tr> <tr> <td>50%</td> <td>in first 72 hours </td></tr> <tr> <td>80%</td> <td>in two weeks </td></tr> <tr> <td>90%</td> <td>in first month </td></tr></tbody></table> <p>Of all people with aortic dissection, 40% die immediately and do not reach a hospital in time. Of the remainder, 1% die every hour, making prompt diagnosis and treatment a priority. Even after diagnosis, 5–20% die during surgery or in the immediate postoperative period.<sup id="cite_ref-Hiratzka2010_25-1" class="reference"><a href="#cite_note-Hiratzka2010-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> In ascending aortic dissection, if surgery is decided to be not appropriate, 75% die within 2 weeks. With aggressive treatment, 30-day survival for thoracic dissections may be as high as 90%.<sup id="cite_ref-Woo2009_44-0" class="reference"><a href="#cite_note-Woo2009-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=24" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Establishing the incidence of aortic dissection has been difficult because many cases are only diagnosed after death (which may have been attributed to another cause), and is often initially misdiagnosed. Aortic dissection affects an estimated 2.0–3.5 people per every 100,000 every year. Studies from Sweden suggest that the incidence of aortic dissection may be rising.<sup id="cite_ref-Olsson2006_45-0" class="reference"><a href="#cite_note-Olsson2006-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> Men are more commonly affected than women: 65% of all people with aortic dissection are male. The mean age at diagnosis is 63 years.<sup id="cite_ref-Hiratzka2010_25-2" class="reference"><a href="#cite_note-Hiratzka2010-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> In females before the age of 40, half of all aortic dissections occur during <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a> (typically in the third trimester or early <a href="/wiki/Postpartum" class="mw-redirect" title="Postpartum">postpartum</a> period).<sup id="cite_ref-Ardehali2013_46-0" class="reference"><a href="#cite_note-Ardehali2013-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> Dissection occurs in about 0.6% of pregnancies.<sup id="cite_ref-pmid26604124_47-0" class="reference"><a href="#cite_note-pmid26604124-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=25" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The earliest fully documented case of aortic dissection is attributed to <a href="/wiki/Frank_Nicholls" title="Frank Nicholls">Frank Nicholls</a> in his <a href="/wiki/Autopsy" title="Autopsy">autopsy</a> report of <a href="/wiki/George_II_of_Great_Britain" title="George II of Great Britain">King George II of Great Britain</a>, who had been found dead on 25 October 1760; the report describes a dissection of the aortic arch and into the pericardium.<sup id="cite_ref-Criado2011_3-11" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Nicholls1761_48-0" class="reference"><a href="#cite_note-Nicholls1761-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> The term "aortic dissection" was introduced by the French physician J. P. Maunoir in 1802, and <a href="/wiki/Ren%C3%A9_Laennec" title="René Laennec">René Laennec</a> labeled the condition "dissecting aneurysm".<sup id="cite_ref-Criado2011_3-12" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Leonard1979_49-0" class="reference"><a href="#cite_note-Leonard1979-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> London cardiologist <a href="/wiki/Thomas_Bevill_Peacock" title="Thomas Bevill Peacock">Thomas Bevill Peacock</a> contributed to the understanding of the condition by publishing two series of the cases described in the literature so far: 19 cases in an 1843 review, and 80 in 1863.<sup id="cite_ref-Leonard1979_49-1" class="reference"><a href="#cite_note-Leonard1979-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> The characteristic symptom of tearing pain in the chest was recognized in 1855 when a case was diagnosed in life.<sup id="cite_ref-Leonard1979_49-2" class="reference"><a href="#cite_note-Leonard1979-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p><p>Surgery for aortic dissection was first introduced and developed by <a href="/wiki/Michael_E._DeBakey" class="mw-redirect" title="Michael E. DeBakey">Michael E. DeBakey</a>, <a href="/wiki/Denton_Cooley" title="Denton Cooley">Denton Cooley</a>, and Oscar Creech, cardiac surgeons associated with the <a href="/wiki/Baylor_College_of_Medicine" title="Baylor College of Medicine">Baylor College of Medicine</a>, Houston, Texas, in 1954. DeBakey developed aortic dissection himself at age 97 in 2005,<sup id="cite_ref-Criado2011_3-13" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> and underwent surgery in 2006.<sup id="cite_ref-Altman2006_50-0" class="reference"><a href="#cite_note-Altman2006-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> Endovascular treatment of aortic dissection was developed in the 1990s.<sup id="cite_ref-Criado2011_3-14" class="reference"><a href="#cite_note-Criado2011-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Well-known_patients">Well-known patients</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=26" title="Edit section: Well-known patients"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Lucille_Ball" title="Lucille Ball">Lucille Ball</a> was diagnosed with dissecting aortic aneurysm and underwent surgery to repair her aorta and a successful seven-hour aortic valve replacement, but died days later.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> A greater incidence of aortic aneurysm is seen in cigarette smokers; Ball had been a heavy smoker most of her life.<sup id="cite_ref-Lucille_Ball_dies_52-0" class="reference"><a href="#cite_note-Lucille_Ball_dies-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup></li></ul> <ul><li>Playwright <a href="/wiki/Jonathan_Larson" title="Jonathan Larson">Jonathan Larson</a>, best known for the musical <i><a href="/wiki/Rent_(musical)" title="Rent (musical)">Rent</a></i>, died in 1996 of an aortic dissection believed to be due to undiagnosed <a href="/wiki/Marfan_Syndrome" class="mw-redirect" title="Marfan Syndrome">Marfan Syndrome</a>.</li></ul> <ul><li>Ritter Rules are a compilation of reminders, symptoms, and risk factors designed to prevent the misdiagnosis of thoracic aortic dissection.<sup id="cite_ref-tadcoalition.36beta.com_53-0" class="reference"><a href="#cite_note-tadcoalition.36beta.com-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> The rules were named after <i><a href="/wiki/Three%27s_Company" title="Three's Company">Three's Company</a></i> star <a href="/wiki/John_Ritter" title="John Ritter">John Ritter</a>, who died from a thoracic aortic dissection in 2003 after he was misdiagnosed and falsely treated for a heart attack by his two doctors.<sup id="cite_ref-CBS_News_54-0" class="reference"><a href="#cite_note-CBS_News-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> The rules were developed by Dianna Milewicz of the <a href="/wiki/University_of_Texas_Health_Science_Center_at_Houston" title="University of Texas Health Science Center at Houston">University of Texas Health Science Center at Houston</a> seven years after Ritter's death, and were jointly published by the non-profit organization in Ritter's honor and the Thoracic Aortic Disease Coalition.<sup id="cite_ref-tadcoalition.36beta.com_53-1" class="reference"><a href="#cite_note-tadcoalition.36beta.com-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-CBS_News_54-1" class="reference"><a href="#cite_note-CBS_News-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup></li></ul> <ul><li><i><a href="/wiki/Days_of_Our_Lives" title="Days of Our Lives">Days of Our Lives</a></i> and <i><a href="/wiki/Babylon_5" title="Babylon 5">Babylon 5</a></i> actor <a href="/wiki/Richard_Biggs" title="Richard Biggs">Richard Biggs</a> died in 2004, at the age of 44 due to complications from aortic dissection.<sup id="cite_ref-56" class="reference"><a href="#cite_note-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup></li></ul> <ul><li><a href="/wiki/Lux_Interior" title="Lux Interior">Lux Interior</a> of <a href="/wiki/The_Cramps" title="The Cramps">The Cramps</a> died at the Glendale Memorial Hospital in 2009, at the age of 62, following an aortic dissection which, contrary to initial reports about a pre-existing condition, was "sudden, shocking and unexpected".<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup></li></ul> <ul><li><a href="/wiki/Alan_Thicke" title="Alan Thicke">Alan Thicke</a> died in 2016 of type-A aortic dissection at the <a href="/wiki/Providence_Saint_Joseph_Medical_Center" title="Providence Saint Joseph Medical Center">Providence Saint Joseph Medical Center</a> in Burbank, at the age of 69.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup></li></ul> <ul><li>Japanese actress <a href="/wiki/Hiromi_Tsuru" title="Hiromi Tsuru">Hiromi Tsuru</a> died in her car from aortic dissection in 2017 at the age of 57.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup></li></ul> <ul><li>Taiwanese entertainer <a href="/wiki/Alien_Huang" title="Alien Huang">Alien Huang</a> died in 2020 at the age of 36.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup></li></ul> <ul><li><a href="/wiki/Kentaro_Miura" title="Kentaro Miura">Kentaro Miura</a>, writer and artist of the manga <i><a href="/wiki/Berserk_(manga)" title="Berserk (manga)">Berserk</a></i>, died from aortic dissection in 2021 at the age of 54.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup></li></ul> <ul><li>In August 2021, New Zealand <a href="/wiki/Cricket" title="Cricket">cricketer</a> <a href="/wiki/Chris_Cairns" title="Chris Cairns">Chris Cairns</a> was put on full life support following an aortic dissection in his home in <a href="/wiki/Canberra" title="Canberra">Canberra, Australia</a>. He was transferred to <a href="/wiki/Sydney" title="Sydney">Sydney</a>,<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> and became paralysed from the waist down due to sustaining a stroke during surgery.</li></ul> <ul><li>41-year-old guitarist <a href="/wiki/Richie_Faulkner" title="Richie Faulkner">Richie Faulkner</a> of the heavy metal band <a href="/wiki/Judas_Priest" title="Judas Priest">Judas Priest</a> had an aortic aneurysm on September 27, 2021, in the middle of the final song of their 50-minute set at a music festival. He underwent <style data-mw-deduplicate="TemplateStyles:r1154941027">.mw-parser-output .frac{white-space:nowrap}.mw-parser-output .frac .num,.mw-parser-output .frac .den{font-size:80%;line-height:0;vertical-align:super}.mw-parser-output .frac .den{vertical-align:sub}.mw-parser-output .sr-only{border:0;clip:rect(0,0,0,0);clip-path:polygon(0px 0px,0px 0px,0px 0px);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px}</style><span class="frac">10<span class="sr-only">+</span><span class="num">1</span>⁄<span class="den">2</span></span> hours of open heart surgery to repair the aortic dissection.<sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup></li></ul> <ul><li>In 2022, keyboardist <a href="/wiki/Andy_Fletcher_(musician)" title="Andy Fletcher (musician)">Andy Fletcher</a>, a founding member of the UK band <a href="/wiki/Depeche_Mode" title="Depeche Mode">Depeche Mode</a>, died unexpectedly at home from an aortic dissection, at the age of 60.<sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=27" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Carotid_artery_dissection" title="Carotid artery dissection">Carotid artery dissection</a></li> <li><a href="/wiki/Vertebral_artery_dissection" title="Vertebral artery dissection">Vertebral artery dissection</a></li> <li><a href="/wiki/Isolated_Superior_Mesenteric_Artery_Dissection_(ISMAD)" class="mw-redirect" title="Isolated Superior Mesenteric Artery Dissection (ISMAD)">Isolated Superior Mesenteric Artery Dissection (ISMAD)</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=28" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Lancet2016-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-Lancet2016_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-12"><sup><i><b>m</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-13"><sup><i><b>n</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-14"><sup><i><b>o</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-15"><sup><i><b>p</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-16"><sup><i><b>q</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-17"><sup><i><b>r</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-18"><sup><i><b>s</b></i></sup></a> <a href="#cite_ref-Lancet2016_1-19"><sup><i><b>t</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output 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Retrieved <span class="nowrap">December 13,</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Actor+Alan+Thicke%2C+dad+on+Growing+Pains%2C+dead+at+69&rft.place=San+Francisco&rft.pub=Reuters&rft.date=2016-12-13&rft.aulast=Skinner&rft.aufirst=Curtis&rft_id=https%3A%2F%2Fwww.reuters.com%2Farticle%2Fus-people-alanthicke-idUSKBN14306R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+dissection" class="Z3988"></span></span> </li> <li id="cite_note-60"><span class="mw-cite-backlink"><b><a href="#cite_ref-60">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.oricon.co.jp/news/2100812/full/">"声優・鶴ひろみさん死去事務所が正式発表運転中に大動脈解離"</a>. <i>Oricon News</i>. 4 February 2018<span class="reference-accessdate">. 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He was 54. Miura-sensei was a master artist and storyteller and we had the great privilege of publishing several of his finest works, including his masterpiece, Berserk"</a> (<a href="/wiki/Tweet_(social_media)" title="Tweet (social media)">Tweet</a>)<span class="reference-accessdate">. Retrieved <span class="nowrap">2021-05-20</span></span> – via <a href="/wiki/Twitter" title="Twitter">Twitter</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Kentaro+Miura+passed+away+on+May+6%2C+2021%2C+from+acute+aortic+dissection.+He+was+54.+Miura-sensei+was+a+master+artist+and+storyteller+and+we+had+the+great+privilege+of+publishing+several+of+his+finest+works%2C+including+his+masterpiece%2C+Berserk.&rft.date=2021-05-20&rft.au=Dark+Horse+Comics&rft_id=https%3A%2F%2Fx.com%2Fdarkhorsecomics%2Fstatus%2F1395245332234002432&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+dissection" class="Z3988"></span></span> </li> <li id="cite_note-63"><span class="mw-cite-backlink"><b><a href="#cite_ref-63">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation audio-visual cs1"><a rel="nofollow" class="external text" href="https://www.youtube.com/watch?v=fuS6SlfjEVU"><i>NZ cricket great Chris Cairns on life support in Australia after major medical event</i></a>. <i>Newshub</i><span class="reference-accessdate">. Retrieved <span class="nowrap">2021-08-10</span></span> – via YouTube.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=NZ+cricket+great+Chris+Cairns+on+life+support+in+Australia+after+major+medical+event&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DfuS6SlfjEVU&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+dissection" class="Z3988"></span></span> </li> <li id="cite_note-64"><span class="mw-cite-backlink"><b><a href="#cite_ref-64">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBlabbermouth2021" class="citation web cs1">Blabbermouth (2021-10-11). <a rel="nofollow" class="external text" href="https://www.blabbermouth.net/news/judas-priests-richie-faulkner-thanks-his-cardiothoracic-surgeon-for-saving-his-life-i-dont-know-how-im-still-around-today/">"Judas Priest's Richie Faulkner Thanks His Cardiothoracic Surgeon For Saving His Life: 'I Don't Know How I'm Still Around Today'<span class="cs1-kern-right"></span>"</a>. <i>Blabbermouth</i><span class="reference-accessdate">. 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UK<span class="reference-accessdate">. Retrieved <span class="nowrap">2022-06-28</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Guardian&rft.atitle=Cause+of+death+of+Depeche+Mode%27s+Andrew+Fletcher+revealed&rft.date=2022-06-28&rft.aulast=Beaumont-Thomas&rft.aufirst=Ben&rft_id=https%3A%2F%2Fwww.theguardian.com%2Fmusic%2F2022%2Fjun%2F28%2Fcause-of-death-of-depeche-modes-andrew-fletcher-revealed&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+dissection" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="Sources">Sources</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=29" title="Edit section: Sources"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFDemersMiller2016" class="citation book cs1">Demers P, Miller DC (2016). "Type A Aortic Dissection". <i>Sabiston and Spencer Surgery of the Chest</i>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-323-24126-7" title="Special:BookSources/978-0-323-24126-7"><bdi>978-0-323-24126-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Type+A+Aortic+Dissection&rft.btitle=Sabiston+and+Spencer+Surgery+of+the+Chest&rft.date=2016&rft.isbn=978-0-323-24126-7&rft.aulast=Demers&rft.aufirst=Philippe&rft.au=Miller%2C+D.+Craig&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+dissection" class="Z3988"></span></li></ul> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Aortic_dissection&action=edit&section=30" title="Edit section: External links"><span>edit</span></a><span 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style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammation</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arteritis" title="Arteritis">Arteritis</a> <ul><li><a href="/wiki/Aortitis" title="Aortitis">Aortitis</a></li></ul></li> <li><a href="/wiki/Thromboangiitis_obliterans" title="Thromboangiitis obliterans">Buerger's disease</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Arteriosclerosis" title="Arteriosclerosis">Arteriosclerosis</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Atherosclerosis" title="Atherosclerosis">Atherosclerosis</a> <ul><li><a href="/wiki/Foam_cell" title="Foam cell">Foam cell</a></li> <li><a href="/wiki/Fatty_streak" title="Fatty streak">Fatty streak</a></li> <li><a href="/wiki/Atheroma" title="Atheroma">Atheroma</a></li> <li><a href="/wiki/Cholesterol" title="Cholesterol">Cholesterol</a></li> <li><a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">LDL</a></li> <li><a href="/wiki/Oxycholesterol" title="Oxycholesterol">Oxycholesterol</a></li> <li><a href="/wiki/Trans_fat" title="Trans fat">Trans fat</a></li></ul></li> <li><a href="/wiki/Monckeberg%27s_arteriosclerosis" title="Monckeberg's arteriosclerosis">Monckeberg's arteriosclerosis</a></li> <li><a href="/wiki/Hyaline_arteriolosclerosis" class="mw-redirect" title="Hyaline arteriolosclerosis">Hyaline arteriolosclerosis</a></li> <li><a href="/wiki/Hyperplastic_arteriolosclerosis" class="mw-redirect" title="Hyperplastic arteriolosclerosis">Hyperplastic arteriolosclerosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Peripheral_artery_disease" title="Peripheral artery disease">Peripheral artery disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Stenosis" title="Stenosis">Stenosis</a> <ul><li><a href="/wiki/Carotid_artery_stenosis" title="Carotid artery stenosis">Carotid artery stenosis</a></li> <li><a href="/wiki/Renal_artery_stenosis" title="Renal artery stenosis">Renal artery stenosis</a></li></ul></li> <li><a href="/wiki/Aortoiliac_occlusive_disease" title="Aortoiliac occlusive disease">Aortoiliac occlusive disease</a></li> <li><a href="/wiki/Critical_limb_ischemia" class="mw-redirect" title="Critical limb ischemia">Critical limb ischemia</a></li> <li><a href="/wiki/Degos_disease" title="Degos disease">Degos disease</a></li> <li><a href="/wiki/Erythromelalgia" title="Erythromelalgia">Erythromelalgia</a></li> <li><a href="/wiki/Fibromuscular_dysplasia" title="Fibromuscular dysplasia">Fibromuscular dysplasia</a></li> <li><a href="/wiki/Hepatic_artery_thrombosis" title="Hepatic artery thrombosis">Hepatic artery thrombosis</a></li> <li><a href="/wiki/Intermittent_claudication" title="Intermittent claudication">Intermittent claudication</a></li> <li><a href="/wiki/Raynaud%27s_phenomenon" class="mw-redirect" title="Raynaud's phenomenon">Raynaud's phenomenon</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aneurysm" title="Aneurysm">Aneurysm</a> / <a href="/wiki/Dissection_(medical)" class="mw-redirect" title="Dissection (medical)">dissection</a> /<br /> <a href="/wiki/Pseudoaneurysm" title="Pseudoaneurysm">pseudoaneurysm</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i>torso</i>: <a href="/wiki/Aortic_aneurysm" title="Aortic aneurysm">Aortic aneurysm</a> <ul><li><a href="/wiki/Abdominal_aortic_aneurysm" title="Abdominal aortic aneurysm">Abdominal aortic aneurysm</a></li> <li><a href="/wiki/Thoracic_aortic_aneurysm" title="Thoracic aortic aneurysm">Thoracic aortic aneurysm</a></li> <li><a href="/wiki/Aneurysm_of_sinus_of_Valsalva" title="Aneurysm of sinus of Valsalva">Aneurysm of sinus of Valsalva</a></li></ul></li> <li><a class="mw-selflink selflink">Aortic dissection</a></li> <li><a href="/wiki/Aortic_rupture" title="Aortic rupture">Aortic rupture</a></li> <li><a href="/wiki/Coronary_artery_aneurysm" title="Coronary artery aneurysm">Coronary artery aneurysm</a></li> <li><i>head / neck</i> <ul><li><a href="/wiki/Intracranial_aneurysm" title="Intracranial aneurysm">Intracranial aneurysm</a></li> <li><a href="/wiki/Intracranial_berry_aneurysm" class="mw-redirect" title="Intracranial berry aneurysm">Intracranial berry aneurysm</a></li> <li><a href="/wiki/Carotid_artery_dissection" title="Carotid artery dissection">Carotid artery dissection</a></li> <li><a href="/wiki/Vertebral_artery_dissection" title="Vertebral artery dissection">Vertebral artery dissection</a></li> <li><a href="/wiki/Familial_aortic_dissection" title="Familial aortic dissection">Familial aortic dissection</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vascular_malformation" title="Vascular malformation">Vascular malformation</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arteriovenous_fistula" title="Arteriovenous fistula">Arteriovenous fistula</a></li> <li><a href="/wiki/Arteriovenous_malformation" title="Arteriovenous malformation">Arteriovenous malformation</a></li> <li><a href="/wiki/Telangiectasia" title="Telangiectasia">Telangiectasia</a> <ul><li><a href="/wiki/Hereditary_hemorrhagic_telangiectasia" title="Hereditary hemorrhagic telangiectasia">Hereditary hemorrhagic telangiectasia</a></li> <li><a href="/wiki/Generalized_essential_telangiectasia" title="Generalized essential telangiectasia">Generalized essential telangiectasia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nevus#Vascular_nevus" title="Nevus">Vascular nevus</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cherry_hemangioma" class="mw-redirect" title="Cherry hemangioma">Cherry hemangioma</a></li> <li><a href="/wiki/Halo_nevus" title="Halo nevus">Halo nevus</a></li> <li><a href="/wiki/Spider_angioma" title="Spider angioma">Spider angioma</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vein" title="Vein">Veins</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammation</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Phlebitis" title="Phlebitis">Phlebitis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Venous_thrombosis" title="Venous thrombosis">Venous thrombosis</a> /<br /> <a href="/wiki/Thrombophlebitis" title="Thrombophlebitis">Thrombophlebitis</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i>primarily lower limb</i> <ul><li><a href="/wiki/Deep_vein_thrombosis" title="Deep vein thrombosis">Deep vein thrombosis</a></li></ul></li> <li><i>abdomen</i> <ul><li><a href="/wiki/Hepatic_veno-occlusive_disease" title="Hepatic veno-occlusive disease">Hepatic veno-occlusive disease</a></li> <li><a href="/wiki/Budd%E2%80%93Chiari_syndrome" title="Budd–Chiari syndrome">Budd–Chiari syndrome</a></li> <li><a href="/wiki/May%E2%80%93Thurner_syndrome" title="May–Thurner syndrome">May–Thurner syndrome</a></li> <li><a href="/wiki/Portal_vein_thrombosis" title="Portal vein thrombosis">Portal vein thrombosis</a></li> <li><a href="/wiki/Renal_vein_thrombosis" title="Renal vein thrombosis">Renal vein thrombosis</a></li></ul></li> <li><i>upper limb / torso</i> <ul><li><a href="/wiki/Mondor%27s_disease" class="mw-redirect" title="Mondor's disease">Mondor's disease</a></li> <li><a href="/wiki/Paget%E2%80%93Schroetter_disease" title="Paget–Schroetter disease">Paget–Schroetter disease</a></li> <li><a href="/wiki/Pulmonary_embolism" title="Pulmonary embolism">Pulmonary embolism</a></li></ul></li> <li><i>head</i> <ul><li><a href="/wiki/Cerebral_venous_sinus_thrombosis" title="Cerebral venous sinus thrombosis">Cerebral venous sinus thrombosis</a></li></ul></li> <li><a href="/wiki/Post-thrombotic_syndrome" title="Post-thrombotic syndrome">Post-thrombotic syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Varicose_veins" title="Varicose veins">Varicose veins</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gastric_varices" title="Gastric varices">Gastric varices</a></li> <li><a href="/wiki/Portacaval_anastomosis" title="Portacaval anastomosis">Portacaval anastomosis</a> <ul><li><a href="/wiki/Caput_medusae" title="Caput medusae">Caput medusae</a></li> <li><a href="/wiki/Esophageal_varices" title="Esophageal varices">Esophageal varices</a></li> <li><a href="/wiki/Hemorrhoid" title="Hemorrhoid">Hemorrhoid</a></li></ul></li> <li><a href="/wiki/Varicocele" title="Varicocele">Varicocele</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chronic_venous_insufficiency" title="Chronic venous insufficiency">Chronic venous insufficiency</a></li> <li><a href="/wiki/Chronic_cerebrospinal_venous_insufficiency" class="mw-redirect" title="Chronic cerebrospinal venous insufficiency">Chronic cerebrospinal venous insufficiency</a></li> <li><a href="/wiki/Superior_vena_cava_syndrome" title="Superior vena cava syndrome">Superior vena cava syndrome</a></li> <li><a href="/wiki/Inferior_vena_cava_syndrome" title="Inferior vena cava syndrome">Inferior vena cava syndrome</a></li> <li><a href="/wiki/Venous_ulcer" title="Venous ulcer">Venous ulcer</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Arteries or veins</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Angiopathy" title="Angiopathy">Angiopathy</a> <ul><li><a href="/wiki/Macroangiopathy" class="mw-redirect" title="Macroangiopathy">Macroangiopathy</a></li> <li><a href="/wiki/Microangiopathy" title="Microangiopathy">Microangiopathy</a></li></ul></li> <li><a href="/wiki/Embolism" title="Embolism">Embolism</a> <ul><li><a href="/wiki/Pulmonary_embolism" title="Pulmonary embolism">Pulmonary embolism</a></li> <li><a href="/wiki/Cholesterol_embolism" title="Cholesterol embolism">Cholesterol embolism</a></li> <li><a href="/wiki/Paradoxical_embolism" title="Paradoxical embolism">Paradoxical embolism</a></li></ul></li> <li><a href="/wiki/Thrombosis" title="Thrombosis">Thrombosis</a></li> <li><a href="/wiki/Vasculitis" title="Vasculitis">Vasculitis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Blood_pressure" title="Blood pressure">Blood pressure</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hypertension" title="Hypertension">Hypertension</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypertensive_heart_disease" title="Hypertensive heart disease">Hypertensive heart disease</a></li> <li><a href="/wiki/Hypertensive_emergency" title="Hypertensive emergency">Hypertensive emergency</a></li> <li><a href="/wiki/Hypertensive_nephropathy" class="mw-redirect" title="Hypertensive nephropathy">Hypertensive nephropathy</a></li> <li><a href="/wiki/Essential_hypertension" title="Essential hypertension">Essential hypertension</a></li> <li><a href="/wiki/Secondary_hypertension" title="Secondary hypertension">Secondary hypertension</a> <ul><li><a href="/wiki/Renovascular_hypertension" title="Renovascular hypertension">Renovascular hypertension</a></li></ul></li> <li><a href="/wiki/Benign_hypertension" title="Benign hypertension">Benign hypertension</a></li> <li><a href="/wiki/Pulmonary_hypertension" title="Pulmonary hypertension">Pulmonary hypertension</a></li> <li><a href="/wiki/Systolic_hypertension" title="Systolic hypertension">Systolic hypertension</a></li> <li><a href="/wiki/White_coat_hypertension" title="White coat hypertension">White coat hypertension</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hypotension" title="Hypotension">Hypotension</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Orthostatic_hypotension" title="Orthostatic hypotension">Orthostatic hypotension</a></li> <li><a href="/wiki/Shock_(circulatory)" title="Shock (circulatory)">Shock (circulatory)</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q594660" class="extiw" title="d:Q594660">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/I71.0">I71.0</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=441.0">441.0</a></li><li><b><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a></b>: <a rel="nofollow" class="external text" href="https://omim.org/entry/607086">607086</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D000784">D000784</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb805.htm">805</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000181.htm">000181</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/emerg/28-overview">emerg/28</a></li><li><b><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a></b>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/aortic-dissection">Aortic dissection</a></li><li><b><a href="/wiki/GeneReviews" title="GeneReviews">GeneReviews</a></b>: <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/books/NBK1120/">Thoracic Aortic Aneurysms and Aortic Dissections</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><style data-mw-deduplicate="TemplateStyles:r1038841319">.mw-parser-output .tooltip-dotted{border-bottom:1px dotted;cursor:help}</style></div><div role="navigation" class="navbox authority-control" aria-label="Navbox" style="padding:3px"><table class="nowraplinks hlist navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Help:Authority_control" title="Help:Authority control">Authority control databases</a>: National <span class="mw-valign-text-top noprint" typeof="mw:File/Frameless"><a href="https://www.wikidata.org/wiki/Q594660#identifiers" title="Edit this at Wikidata"><img alt="Edit this at Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, 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