Cardiovascular Pathology book series for
USMLE & PLAB
preparition
Aortic Dissection
(AD)
Definition of AD
Aortic dissection is an
emergent condition
characterized by tears
in the innermost layer
(tunica intima) of the
aorta and leading to
the separation of
tunica intima and
tunica media, with the
formation of a new
false channel. This
creates pressure on
the layers of blood
,Fig. 9-01: Dissection of the descending aorta (3), which starts from
the left subclavian artery and extends to the abdominal aorta (4). The
ascending aorta (1) and aortic arch (2) are not involved.
ves- sels that forcibly
separates them,
causing se- vere pain,
characteristically
known as tearing pain.
This is a serious
medical emergency as
it can partially occlude
branches of the aorta
and reduce blood flow
to the rest of the
body, resulting in
insufficient supply of
blood and nu- trients
to the vital organs. In
severe cases, the
aorta can rupture and
cause rapid death.
Epidemiology of AD
Aortic dissection is a
rare condition in which
new cases are
reported at a rate of
2–3.5 per 100,000
people every year. It is
more common in men
than women as 65 %
of all dissections are
reported in males. 50
% of cases of aortic
dissection in women
are reported in
pregnant women
under the age of 40
years (rare).
People aged 40–70 years are more likely to develop this condition, and
account for almost 75 % of dissec- tions. Its peak incidence occurs at 50–
65 years of age. Dissections that occur at 30–40 years of age are usually
associated with genetic predisposition and/or connective tissue diseases such
as Marfan syndrome. 90 % of cases occur in males with hypertension
between the ages of 40 and 60 years. It is more common in Afro-
Caribbean people than Caucasians, as is hypertension. Asians have the
lowest incidence.
,Etiology of AD
Acquired causes
• Hypertension
• Atherosclerosis
• Blunt chest trauma (e.g car accidents, although these are deceleration
injuries that more commonly cause aortic transection, which is the
laceration of all 3 layers of the aorta) or iatrogenic trauma (during
catheterization or intra-aortic balloon pump counterpulsation)
• Pregnancy, especially third trimester and postpartum
• Syphilis (tertiary stage) as this causes vasculitis with aortic involvement
• Amphetamines and cocaine use
• Cardiac surgery – especially aortic valve replacement, as aortic
regurgitation can cause dilation and aortic wall weakening
,
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