Acute Aortic Dissection: Changing Spectrum of Clinicopathologic Findings at Autopsy
M Aron, ER Rodriguez, CD Tan. Cleveland Clinic, Cleveland, OH
Background: Acute aortic dissection continues to be a life-threatening medical emergency with a high mortality rate despite progress in surgical techniques. Death may occur as a direct result of the dissection or as a complication related to the extent of dissection. This study was undertaken to describe the clinicopathologic findings of in-hospital mortality due to acute aortic dissection.
Design: All autopsy cases of acute aortic dissection were retrieved from the pathology archives from January 1993 to June 2009. Relevant clinical and pathologic data, including patient demographics, type of dissection (DeBakey classification), predisposing factors, histopathology findings and cause of death were recorded for analysis. Cases with isolated dissections of branches of the aorta including coronary arteries were excluded from the study.
Results: There were a total of 72 cases with 49 (68 %) males and 23 (32%) females. The age range was from 19-83 years with a median of 65 years. In 22 cases, acute dissection occurred in aortas that already had chronic dissection including 10 that were aneurysmal. Type I dissections were seen in 35 (49%) cases, while 13 (18%) were type II and 24 (33%) were type III. The most common predisposing factor was systemic hypertension (57%), followed by previous cardiovascular surgery (32%) including coronary artery bypass grafting, aortic valve replacement, aneurysm and dissection repair. Other associated risk factors include Marfan's syndrome, Ehler Danlos syndrome, rheumatoid aortitis, giant cell aortitis, and cocaine abuse. Only 18 cases (25%) had cystic medial degeneration on histology. Rupture of the aortic dissection (46%) leading to hemopericardium (16 cases), hemothorax (9) and hemoperitoneum (8) was the most frequent cause of death. Other causes of death included myocardial ischemia, mesenteric ischemia, multiorgan failure and sepsis.
Conclusions: Hypertension remains the most common associated disease in patients presenting with acute aortic dissection at autopsy. However, iatrogenic and postsurgical dissections are seen with increasing frequency and accounts for the second largest group of patients who experienced aortic dissections. A third group of patients at risk for aortic dissection are those with connective tissue disorders and inflammatory aortopathy. Cause of death is often multifactorial, but rupture of dissection most often causes sudden and unexpected demise.
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 1, Monday Morning