UMEM Educational Pearls

Category: Vascular

Title: Type B (distal) Aortic Dissection-Beware of Complications!!

Keywords: aortic dissection (PubMed Search)

Posted: 4/5/2010 by Rob Rogers, MD (Updated: 7/18/2019)
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Some not too uncommon complications of Type B (distal) aortic dissection:

  • Malperfusion syndrome-occurs when the dissection flap occludes a major vessel (e.g. SMA occlusion leading to bowel infarction)
  • Occlusion of the spinal arteries and lower extremity arteries can lead to fleeting signs and symptoms-one minute they have left leg pain and ischemia, the next minute they don't. This is pretty classic for acute, distal aortic dissection. 
  • Frank rupture (dissected aortic wall is weak and prone to aneurysm formation and subsequent rupture)
  • Assume that rupture has occurred (may be intrathoracic or intrabdominal) in a Type B patient who crashes unexpectedly
  • Retrograde extension into the proximal aorta is not common but does occur. Have a low threshold to whip out the sono if the patient deteriorates.