Aortic dissection reporting format: Not sophisticated, but complete.

Aortic dissection reporting format: Not sophisticated, but complete.

August 2, 2024 by dr s venkatesan

Although foundational and prodigious, transferring past De-bakey ,Stanford is a necessity within the administration of Aortic dissections in present occasions. Step one is to grasp the right 3 dimensional anatomy of whole Aorta from its origin to bifurcation and even past. (The 11 or12 phase demarcation of aorta is effectively established and gained acceptance.)

The society of vascular surgical procedure and society for thoracic surgical procedure has come out with land mark nomenclature in 2020.

This labeling tells us immediately about whether or not the dissection is A, B, or Indeterminate .It additionally reveal the origin of dissection, extent of dissection and the exit level, if accessible.

Naming & coding of Aortic dissection

Aortic dissection : Administration cues

The above scheme is simply part of Preliminary work up with the assistance of MR angiogram or spiral CT. There are extra essential elements like, medical stability, time since dissection, false vs true lumen identification, its quantity ,fee of propagation, quantity, department involvement, mal-perfusion , and many others must be counted.

The curious Irony about this dreaded entity lies in the truth that in kind A dissection, the surgical staff must be alerted effectively earlier than they embark on this most advanced cardiovascular emergency, normally in a cutting-edge CTVS unit. In the meantime, most uncomplicated kind B dissection calls for complete inactivity on the a part of surgeon(in addition to some cardiologists !) whereas the sufferers may be casually shifted to the intensive care ward, primarily for monitoring , mattress relaxation and few medication to scale back BP and shearing stress on aortic wall. The dissection can heal themselves.

The position of Interventional cardiology in Aortic dissection is evolving quickly , nonetheless at greatest supportive or should purchase time to bridge to surgical procedure in some late presenting kind A dissection. There was lot of expertise in some facilities, the place kind B dissections are completely managed by scaffolding. However, the priority is, catheter based mostly Interventions in low danger subsets of dissection is all the time a difficult determination.

Medical methods ought to by no means be appeared down upon as enemy of endovascular Interventions. So, one of many dwell and debatable challenge is, how & the place can we fit-in the hyper-talented endovascular Interventionists within the advanced vascular enviornment of aortic dissection.

Reference

Lombardi J.V., Hughes G.C., Appoo J.J., et al. “Society for Vascular Surgical procedure (SVS) and Society of Thoracic Surgeons (STS) reporting requirements for kind B aortic dissections”. Ann Thorac Surg. 2020;109:959-981