2.0 Classification of Aortic Dissection

Several classifications of aortic dissection are classically used throughout the medical world, with the most significant of them being the DeBakey and Stanford classifications (Gawinecka, Schönrath and von Eckardstein, 2017). The DeBakey system consists of three types of dissection: Type I, II and III (Gawinecka, Schönrath and von Eckardstein, 2017). In Type I aortic dissection the tear arises in the ascending aorta and may include the arch and descending aorta. In Type II dissection the tear is confined to the ascending aorta whereas in Type III dissection the tear is limited to the descending aorta (DEBAKEYet al. , 1965). The Stanford classification system simplifies this and divides aortic dissection into two types: type A involving the ascending aorta and type B, involving the descending aorta distal to the left subclavian artery (Figure 1) (Rylski et al. , 2017; Gawinecka, Schönrath and von Eckardstein, 2017).
INSERT FIGURE 1
However, neither of these classifications address dissections involving the aortic arch alone or dissections comprising of the aortic arch and the descending aorta. When the dissection is limited to the aortic arch or can be described as a retrograde dissection arising from the descending aorta that extends into the arch and stops before the ascending aorta; these dissections are then termed as non-A non-B aortic dissections (Carino et al. , 2019) (Urbanski and Wagner, 2016). The Contemporary classifications such as the TEM (Type, Entry and Malperfusion) aortic dissection classification include non-A non-B dissections (Sievers et al. , 2020).