Stanford classification of aortic dissection
Updates to Article Attributes
Along with the DeBakey classification, the Stanford classification7 is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management. The Stanford classification divides dissections by the most proximal involvement:
-
type A: A affects ascending aorta
andarch- accounts for ~60% of aortic dissections
- surgical management
- may result in:
- coronary artery occlusion
- aortic incompetence
- rupture into the pericardial sac with resulting cardiac tamponade
-
type B: B begins beyond brachiocephalic vessels
- accounts for ~40% of aortic dissections
- dissection commences distal to the left subclavian artery
- medical management with blood pressure control
A special case that is neither reflected in the original Stanford nor the DeBakey classification are dissections that originate frominvolve the arch or extend proximally into theaortic arch without the involvement ofbut not the ascending aorta (between 8 and 15% of all aortic dissections4). Nomenclature of these arch dissections has been incoherent for decades and still is.American surgical consensus (2020) defines types A and B according to location of the intimal tear (type B: all dissections with tear distal to the runoff of the brachiocaphalic trunc with additional qualifiers for proximal and distal extent).5In contrast, some postulating thesea European surgical consensus document (2018) recognises dissections with retrograde extent or proximal tear in the arch dissections to be called type B as they can often be managed medically.4 However, it has been recognized that different outcomestreatment strategies justifyleft subclavian artery) as a distinct category, and the termtermed "non-A-non-B dissection" has gained increasing popularity, which has also been introduced in.6
Case 10 is an example of a 2019type A dissection according to the American surgical definition that might already fall into category non-A-non-B dissection following European surgical consensus document.5
In 2014, a special report was published in Radiology 4 that recognised an uncommon form of aortic dissection. The authors describe dissections that originate from the arch or extend proximally into the arch without the involvement of the ascending aorta which are not adequately accounted for in the Stanford nor the DeBakey classification systems. Dissections in this region, without the involvement of the ascending aorta proximal to the brachiocephalic trunk, are managed medically rather than surgically, provided there is no end-organ ischaemia. Hence, the authors proposed that any dissection originating from the arch between the brachiocephalic trunk and left subclavian artery and not involving the ascending aorta proximal to the brachiocephalic trunk be classified as a type B dissection. See case 10 for an example.
-<p>Along with the <a href="/articles/debakey-classification">DeBakey classification</a>, the <strong>Stanford classification</strong> is used to separate <a href="/articles/aortic-dissection">aortic dissections</a> into those that need surgical repair, and those that usually require only medical management. The Stanford classification divides dissections by the most proximal involvement:</p><ul>- +<p>Along with the <a href="/articles/debakey-classification">DeBakey classification</a>, the <strong>Stanford classification</strong><sup>7</sup> is used to separate <a href="/articles/aortic-dissection">aortic dissections</a> into those that need surgical repair, and those that usually require only medical management. The Stanford classification divides dissections by the most proximal involvement:</p><ul>
-<strong>type A:</strong> <strong>A a</strong>ffects <strong>a</strong>scending <strong>a</strong>orta and <strong>a</strong>rch<ul>- +<strong>type A:</strong> <strong>A a</strong>ffects <strong>a</strong>scending <strong>a</strong>orta<ul>
-</ul><p>A special case that is neither reflected in the Stanford nor the DeBakey classification are dissections that originate from the arch or extend proximally into the arch without the involvement of the ascending aorta (between 8 and 15% of all aortic dissections<sup>4</sup>). Nomenclature of these arch dissections has been incoherent for decades, some postulating these arch dissections to be called type B as they can often be managed medically.<sup>4</sup> However, it has been recognized that different outcomes and treatment strategies justify a distinct category, and the term "non-A-non-B dissection" has gained increasing popularity, which has also been introduced in a 2019 European surgical consensus document.<sup>5</sup></p><p> </p><p>In 2014, a special report was published in <a href="/articles/radiology-journal">Radiology</a><sup> 4</sup> that recognised an uncommon form of aortic dissection. The authors describe dissections that originate from the arch or extend proximally into the arch without the involvement of the ascending aorta which are not adequately accounted for in the Stanford nor the DeBakey classification systems. Dissections in this region, without the involvement of the ascending aorta proximal to the brachiocephalic trunk, are managed medically rather than surgically, provided there is no end-organ ischaemia. Hence, the authors proposed that any dissection originating from the arch between the brachiocephalic trunk and left subclavian artery and not involving the ascending aorta proximal to the brachiocephalic trunk be classified as a type B dissection. See case 10 for an example.</p>- +</ul><p>A special case that is neither reflected in the original Stanford nor the DeBakey classification are dissections that involve the aortic arch but not the ascending aorta (between 8 and 15% of all aortic dissections<sup>4</sup>). Nomenclature of these arch dissections has been incoherent for decades and still is.<br>American surgical consensus (2020) defines types A and B according to location of the intimal tear (type B: all dissections with tear distal to the runoff of the brachiocaphalic trunc with additional qualifiers for proximal and distal extent).<sup>5</sup><br>In contrast, a European surgical consensus document (2018) recognises dissections with retrograde extent or proximal tear in the arch (between the brachiocephalic trunc and left subclavian artery) as a distinct category, termed "non-A-non-B dissection".<sup>6</sup></p><p>Case 10 is an example of a type A dissection according to the American surgical definition that might already fall into category non-A-non-B dissection following European surgical consensus.</p>
References changed:
- 5. Lombardi J, Hughes G, Appoo J et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) Reporting Standards for Type B Aortic Dissections. Ann Thorac Surg. 2020;109(3):959-81. <a href="https://doi.org/10.1016/j.athoracsur.2019.10.005">doi:10.1016/j.athoracsur.2019.10.005</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/32000979">Pubmed</a>
- 6. Czerny M, Schmidli J, Adler S et al. Editor's Choice - Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2019;57(2):165-98. <a href="https://doi.org/10.1016/j.ejvs.2018.09.016">doi:10.1016/j.ejvs.2018.09.016</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30318395">Pubmed</a>
- 7. Daily P, Trueblood H, Stinson E, Wuerflein R, Shumway N. Management of Acute Aortic Dissections. Ann Thorac Surg. 1970;10(3):237-47. <a href="https://doi.org/10.1016/s0003-4975(10)65594-4">doi:10.1016/s0003-4975(10)65594-4</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/5458238">Pubmed</a>
- 5. Czerny M, Schmidli J, Adler S, van den Berg JC, Bertoglio L, Carrel T, Chiesa R, Clough RE, Eberle B, Etz C, Grabenwöger M, Haulon S, Jakob H, Kari FA, Mestres CA, Pacini D, Resch T, Rylski B, Schoenhoff F, Shrestha M, von Tengg-Kobligk H, Tsagakis K, Wyss TR, Document Reviewers, Chakfe N, Debus S, de Borst GJ, Di Bartolomeo R, Lindholt JS, Ma WG, Suwalski P, Vermassen F, Wahba A, Wyler von Ballmoos MC. Editor's Choice - Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). (2019) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 57 (2): 165-198. <a href="https://doi.org/10.1016/j.ejvs.2018.09.016">doi:10.1016/j.ejvs.2018.09.016</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30318395">Pubmed</a> <span class="ref_v4"></span>
Image 12 CT (C+ arterial phase) ( update )
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