Critical Care Scenarios Episode 66: Aortic dissection with Travis Hughes
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Oct 11, 2023 Travis Hughes, vascular surgery fellow from the University of Kentucky, discusses aortic dissection, advancements in treatment, managing impulse and blood pressure, medications, patient monitoring, blood pressure and heart rate control, use of anti-platelet medications, and long-term complications in aortic dissection repairs.
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Anatomy And Modern Classification Shift
- Aortic dissection is an intimal tear creating a false lumen that can extend proximally or distally and affect branch vessels.
- Classification is shifting from Stanford A/B to zone-based 0–11 mapping to guide therapy more precisely.
Treat Type B As Medical Unless Complicated
- Manage most type B dissections medically but treat any signs of malperfusion, uncontrolled pressure, or impending rupture as indications for intervention.
- Recognize that complicated type B dissection (bowel, renal, limb ischemia) needs urgent operative consideration.
Aggressive But Individualized Impulse Control
- Target heart rate below 80 bpm and systolic BP around 120 mmHg for acute impulse control, but individualize based on baseline physiology.
- If perfusion or mental status worsens when lowered, relax targets appropriately and consider intervention.