A new classification system, which includes the type of dissection (adapting Stanford system A, B or non-A non-B), the location of the primary entry tear, and the presence of malperfusion (TEM) has been introduced, but is yet awaiting community acceptance. Several studies suggest that arch dissections could lead to organ malperfusion and aortic rupture, which require prompt intervention and careful management. These patients develop a dissection originating from the aortic arch, or the descending aorta and retrogradely involve the arch, without involving the ascending aorta. Recently, a unique group, so-called non-A non-B, which does not completely fit DeBakey and Standford classification has been identified. Stanford classification helps indicate different management for dissection cases in clinical practise: Type A dissections involve the ascending aorta (DeBakey type I and II), usually requiring swift surgery while Type B dissections only involve the descending aorta (DeBakey type III) and can be managed endovascularly or medically ( Figure 2). DeBakey classification precisely describes the site of the dissected segment or diseased lesion: Type I dissections usually originate from the ascending aorta and have the most extensive involvement including the ascending aorta, aortic arch, descending aorta and further Type II dissections originate from and are only limited to the ascending aorta Type III dissections originate from the descending aorta after the left subclavian artery orifice, and affects the descending aorta (Type IIIa) and/or distal abdominal aorta (Type IIIb). The two most frequent anatomic classification systems are: DeBakey classification, which is based on the site of origin of the intimal tear and Stanford classification, which specifies the involvement, or lack thereof, of the ascending aorta. Īortic dissection can be categorized in different ways in terms of anatomy and symptom onset. The number of cases of acute aortic dissection seems to be rising in Western countries, possibly related to increased awareness of the disease, as well as access to the use of advanced imaging techniques (particularly CT) in emergency departments. Interestingly, the demographic forecasts from the UK Office for National Statistics predicts that the incidence of aortic dissection will rise from 3892 in 2010 to 6893 in 2050 in both men and women, with the majority occurring in individuals over 75. The real-world incidence may be underestimated due to omission of pre-admission deaths in all studies. ![]() Another study from the UK observed 92,728 patients over 10 years, and reported a higher incidence (6 per 100,000 person-years) of acute aortic dissection, which is similar to data from Sweden with an incidence of 7.2 per 100,000 person-years. Population-based studies in the US and Europe indicate an incidence of 2.6 to 3.5 cases per 100,000 person-years.
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