A 70-year-old hypertensive man presents to the emergency department with sudden onset tearing chest pain radiating to the back. CT aortography shows a dissection extending from the ascending aorta into the descending thoracic aorta. According to the Stanford classification, this is:

• A Stanford Type B — managed medically unless complications arise
• B Stanford Type A — managed medically
• C Stanford Type B — requires urgent open repair
• D Stanford Type A — requires urgent surgical repair ✓

Explanation

Stanford Type A aortic dissection involves the ascending aorta (regardless of extent) and is a surgical emergency because of the risks of cardiac tamponade, aortic regurgitation, and coronary artery occlusion. Stanford Type B dissections are confined to the descending aorta (distal to the left subclavian) and are initially managed medically with tight blood pressure control unless complicated by end-organ ischaemia, rupture, or rapid expansion.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.