![]() University of Pennsylvania class of clinical presentations in acute type A dissection. The second ischemic profile, classified as Penn presentation class b, is characterized by ‘branch’ vessel malperfusion that results in localized organ ischemia to cause the following: stroke paraplegia renal dysfunction mesenteric ischemia and/or an ischemic extremity. The first ischemic profile, classified as Penn presentation class a, is characterized by the ‘absence’ of ischemia in which the patient is hemodynamically stable with no branch vessel malperfusion. 2 The clinical presentation of type A dissectionĪlthough the clinical presentation of type A dissection is heterogeneous, it may be understood in terms of four ischemic profiles proposed by the thoracic aortic research group at the University of Pennsylvania ( Table 1 ). A management-driven extension of the Stanford classification could provide a common framework essential for outcome comparison and for future trial design. The purpose of this review is to characterize these advances in acute type A dissection and propose a management-driven classification of type A dissection based on clinical presentation and extent. In the current era of TEVAR, the heterogeneity in type A dissection based on clinical presentation and extent increasingly influences management strategies and outcomes, both in the short term and long term. ![]() The second consideration is that TEVAR in acute type A dissection offers alternatives for thoracic aortic repair both related to the proximal and distal extent of the dissection: these endovascular techniques may not only be combined with standard techniques in central aortic reconstruction but may, in selected cases, also be the sole therapy. The first consideration is that malperfusion on presentation of acute type A dissection is not only a major outcome determinant but also may require percutaneous restoration of perfusion with intimal fenestration and/or branch vessel stenting, followed by delayed central aortic reconstruction. Recently, these two advances have merged to offer alternatives in the management of acute type A dissection. This distinction remains important, but does not completely integrate the evolving management of acute aortic dissection due to the outcome importance of clinical presentation and the advances in thoracic endovascular aortic repair (TEVAR). This important consideration is at the heart of the management-driven Stanford classification: type A dissection involves the ascending aorta, whereas type B does not. Type A dissection, Stanford classification, DeBakey classification 1 IntroductionĪ major consideration in the classification of acute aortic dissection is the presence of ascending aortic involvement because this represents an indication for urgent surgery.
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