title: Aortic arch dissection: a controversy of classification.
abstract: Aortic dissections originating in the ascending aorta and descending aorta have been classified as type A and type B dissections, respectively. However, dissections with intimal flap extension into the aortic arch between the innominate and left subclavian arteries are not accounted for adequately in the widely used Stanford classification. This gap has been the subject of controversy in the medical and surgical literature, and there is a tendency among many radiologists to categorize such arch dissections as type A lesions, thus making them an indication for surgery. However, the radiologic perspective is not supported by either standard dissection classification or current clinical management. In this special report, the origin of dissection classification and its evolution into current radiologic interpretation and surgical practice are reviewed. The cause for the widespread misconception about classification and treatment algorithms is identified. Institutional review board approval and waiver of informed consent were obtained as part of this HIPAA-compliant retrospective study to assess all aortic dissection studies performed at the University of Maryland Medical Center, Baltimore between 2010 and 2012 to determine the prevalence of arch dissections. Finally, a unified classification system that reconciles imaging interpretation and management implementation is proposed.
authors.affiliation: From the Departments of Radiology (J.K.L., A.A.F., J.J., S.J.K., R.S., H.A.N., E.K.G., C.S.W.) and Cardiac Surgery (B.G.), University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Lempel
authors.forename: Aletta Ann
authors.initials: AA
authors.lastname: Frazier
authors.forename: Jean
authors.initials: J
authors.lastname: Jeudy
authors.forename: Seth J
authors.initials: SJ
authors.lastname: Kligerman
authors.forename: Randall
authors.initials: R
authors.lastname: Schultz
authors.forename: Hammed A
authors.initials: HA
authors.lastname: Ninalowo
authors.forename: Elliott K
authors.initials: EK
authors.lastname: Gozansky
authors.forename: Bartley
authors.initials: B
authors.lastname: Griffith
authors.forename: Charles S
authors.initials: CS
authors.lastname: White
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000145:classification* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000145:classification* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D012307:Risk Factors; D009626:Terminology as Topic