Original Title: DISSECT: A New Approach to Categorization of Aortic Dissection. Reference: M.D. Dabe, et al. Eur J Vasc Endovasac Surg 2013;46:175-90
Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation – Argentina
Aortic dissection is a lethal disease, especially in its first stages. The current classification systems (DeBakey 1965 and Stanford 1970) are widely used but provide little information, failing to explore all clinical and anatomical aortic features.
The new classification offers a global perspective through different complement diagnostic techniques (TEE, CT, and MRI) to assess the aorta and would help define the best strategy, not just to manage the acute, but to direct the whole course of treatment.
This new classification (DISSECT) uses a fast and simple mnemonic technique of 6 variables: Duration, Intimal tear, Size of aorta, Segmental Extent of involvement, Clinical complication and Thrombosis of false lumen. Duration is classified into acute, subacute and chronic, according to symptom onset (˂2 weeks, 2 weeks to 3 months and >3 months). It is directly associated to prognosis and treatment.
With the new diagnostic technique, we can locate the intimal tear and, as opposed to the traditional classifications, we can locate it in the ascending aorta, the aortic arch, the descending aorta, the abdominal aorta or an unknown location.
These techniques also enables us to better assess aortic diameter in every compromised segment and the extent in each segment, defined by length.
Complications are assessed through the presence of pain, incontrollable hypertension, aortic valve compromise, tamponade, rapture, bad perfusion caused by static or dynamic compromise (stroke, paraplegia, coronary, mesenteric, renal, visceral and/or limbs), proximal or distal progression, rapid growth (>10 mm) of false lumen or aortic diameter.
False lumen thrombosis may be partial, total or there may be patent flow in the different segments of the aorta. The presence of flow in the false lumen has been associated to late death.
Conclusion
This classification not only provides all the anatomical characteristics, it also provides the clinical characteristics, facilitating management with medical, surgical and endovascular treatment of aortic dissection.
Editorial Comment
This classification does not replace the conventional classifications that have been very useful; it only provides more dynamic information about the anatomical and clinical characteristics of aortic dissection. It also expedites assessment both in acute and in evolution, to help direct the course of therapy, be it medical management, open surgical repair or, the most recent alternative, endovascular treatment.