Related Experiment Video
Updated: May 11, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
DISSECT: a new mnemonic-based approach to the categorization of aortic dissection
M D Dake1, M Thompson, M van Sambeek
1Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA 94305-5407, USA. mddake@stanford.edu
Insights
A new classification system, DISSECT, aids in managing aortic dissection by assessing six key features. This system improves therapeutic decision-making, especially with the rise of endovascular techniques for aortic dissection.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Medical Imaging
Background:
- Traditional aortic dissection classification systems (e.g., DeBakey, Stanford) are increasingly inadequate due to the evolving landscape of endovascular interventions.
- The DEFINE Project's Working Group on Aortic Diseases recognized the need for a contemporary system reflecting current therapeutic options.
- Aortic dissection remains a complex and catastrophic vascular emergency requiring precise management strategies.
Purpose of the Study:
- To develop and introduce the DISSECT classification system for aortic dissection.
- To provide a framework that incorporates features crucial for contemporary treatment decisions, including endovascular approaches.
- To enhance clinical communication and guide therapeutic selection for aortic dissection.
Main Methods:
- The DISSECT classification is a mnemonic-based system evaluating six critical characteristics of aortic dissection.
- Key features assessed include: duration of disease, intimal tear location, aortic size, segmental extent, clinical complications, and thrombus presence.
- This approach contrasts with older systems by including factors relevant to endovascular procedures.
Main Results:
- The DISSECT system facilitates a comprehensive assessment of aortic dissection relevant to modern therapeutic options.
- It highlights specific features influencing the choice between medical management, open surgery, or endovascular repair.
- The system addresses limitations of historical classifications in the context of advanced interventional techniques.
Conclusions:
- The DISSECT classification system offers a valuable tool for contemporary aortic dissection management, particularly for type B dissections amenable to endovascular therapy.
- While not directly used for type A aortic dissection repair, it can guide adjunctive interventions for associated complications.
- DISSECT aims to improve decision-making by providing a structured analysis of disease features, moving beyond outdated categorization schemes.
Objective/Background:
Classification systems for aortic dissection provide important guides to clinical decision-making, but the relevance of traditional categorization schemes is being questioned in an era when endovascular techniques are assuming a growing role in the management of this frequently complex and catastrophic entity. In recognition of the expanding range of interventional therapies now used as alternatives to conventional treatment approaches, the Working Group on Aortic Diseases of the DEFINE Project developed a categorization system that features the specific anatomic and clinical manifestations of the disease process that are most relevant to contemporary decision-making.
Methods And Results:
The DISSECT classification system is a mnemonic-based approach to the evaluation of aortic dissection. It guides clinicians through an assessment of six critical characteristics that facilitate optimal communication of the most salient details that currently influence the selection of a therapeutic option, including those findings that are key when considering an endovascular procedure, but are not taken into account by the DeBakey or Stanford categorization schemes. The six features of aortic dissection include: duration of disease; intimal tear location; size of the dissected aorta; segmental extent of aortic involvement; clinical complications of the dissection, and thrombus within the aortic false lumen.
Conclusion:
In current clinical practice, endovascular therapy is increasingly considered as an alternative to medical management or open surgical repair in select cases of type B aortic dissection. Currently, endovascular aortic repair is not used for patients with type A aortic dissection, but catheter-based techniques directed at peripheral branch vessel ischemia that may complicate type A dissection are considered valuable adjunctive interventions, when indicated. The use of a new system for categorization of aortic dissection, DISSECT, addresses the shortcomings of well-known established schemes devised more than 40 years ago, before the introduction of endovascular techniques. It will serve as a guide to support a critical analysis of contemporary therapeutic options and inform management decisions based on specific features of the disease process.
