Hệ thống Stanford là hữu ích vì giá trị tiên lượng vốn có của nó và bởi vì hỗ trợ phân loại trong các quyết định quản lý. Loại A mổ xẻ có một tỷ lệ tử vong cao tới 1% mỗi giờ trong ngày đầu tiên nếu họ không cải tạo đáng kể với điều trị nội khoa. | CHAPTER 17 Aortic Dissection and Dissection-Like Syndromes The Stanford system is useful because of its inherent prognostic value and because classification aids in management decisions. Type A dissections have a high mortality rate up to 1 per hour during the first day if they are not ameliorated considerably with medical therapy. Urgent surgical consultation and repair is therefore indicated for type A dissections. A 6-year series of patients treated with or without surgery showed a mortality rate decrease of more than 50 for the surgically treated group. In contrast most patients with type B dissections can be treated medically. The mortality rate in a recent series of type B dissections that were treated medically was approximately 10 . Surgery for type B dissections typically is reserved for patients with evidence of visceral and major organ compromise limb ischemia refractory pain secondary hypertension or a combination of these symptoms. The risks of mortality and paraplegia are increased for patients who require surgery. Dissection may weaken the wall of the aorta and therefore patients treated medically are at long-term risk for aneurysm formation. For these patients aortic size should be monitored regularly and they should undergo aortic aneurysm repair if they meet the routine repair criteria discussed in detail in Chapter 16 . Risk factors for aortic enlargement include an initial size of 4 cm or larger and a patent false lumen. The mortality rate in a recent series of type B dissections treated medically was 10 Surgery typically is reserved for patients with evidence of visceral and major organ compromise limb ischemia and secondary hypertension Patients should undergo aortic aneurysm repair if they meet routine repair criteria Risk Factors Hypertension is the risk factor most commonly associated with development of aortic dissection. In several large series hypertension was present in 70 of patients. Aortic dissection also is common in older patients
