DISSECT: A new mnemonic-based approach to the categorization of aortic dissection

M. D. Dake, M. Thompson, M. Van Sambeek, F. Vermassen, J. P. Morales

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Objective/Background Classification systems for aortic dissection provide important guides to clinical decision-making, but the relevance of traditional categorization schemes is being questioned in an era when endovascular techniques are assuming a growing role in the management of this frequently complex and catastrophic entity. In recognition of the expanding range of interventional therapies now used as alternatives to conventional treatment approaches, the Working Group on Aortic Diseases of the DEFINE Project developed a categorization system that features the specific anatomic and clinical manifestations of the disease process that are most relevant to contemporary decision-making. Methods and results The DISSECT classification system is a mnemonic-based approach to the evaluation of aortic dissection. It guides clinicians through an assessment of six critical characteristics that facilitate optimal communication of the most salient details that currently influence the selection of a therapeutic option, including those findings that are key when considering an endovascular procedure, but are not taken into account by the DeBakey or Stanford categorization schemes. The six features of aortic dissection include: duration of disease; intimal tear location; size of the dissected aorta; segmental extent of aortic involvement; clinical complications of the dissection, and thrombus within the aortic false lumen. Conclusion In current clinical practice, endovascular therapy is increasingly considered as an alternative to medical management or open surgical repair in select cases of type B aortic dissection. Currently, endovascular aortic repair is not used for patients with type A aortic dissection, but catheter-based techniques directed at peripheral branch vessel ischemia that may complicate type A dissection are considered valuable adjunctive interventions, when indicated. The use of a new system for categorization of aortic dissection, DISSECT, addresses the shortcomings of well-known established schemes devised more than 40 years ago, before the introduction of endovascular techniques. It will serve as a guide to support a critical analysis of contemporary therapeutic options and inform management decisions based on specific features of the disease process.

Original languageEnglish (US)
Pages (from-to)175-190
Number of pages16
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume46
Issue number2
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

Fingerprint

Dissection
Endovascular Procedures
Tunica Intima
Therapeutics
Aortic Diseases
Aorta
Decision Making
Thrombosis
Ischemia
Catheters
Communication

Keywords

  • Aortic dissection
  • Aortic endograft
  • Classification system
  • Dissection type

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

DISSECT : A new mnemonic-based approach to the categorization of aortic dissection. / Dake, M. D.; Thompson, M.; Van Sambeek, M.; Vermassen, F.; Morales, J. P.

In: European Journal of Vascular and Endovascular Surgery, Vol. 46, No. 2, 01.08.2013, p. 175-190.

Research output: Contribution to journalArticle

Dake, M. D. ; Thompson, M. ; Van Sambeek, M. ; Vermassen, F. ; Morales, J. P. / DISSECT : A new mnemonic-based approach to the categorization of aortic dissection. In: European Journal of Vascular and Endovascular Surgery. 2013 ; Vol. 46, No. 2. pp. 175-190.
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