DISSECT Mnemonic System Developed to Categorize Aortic Dissection

July 25, 2013—A new mnemonic-based approach to aid the categorization of aortic dissection was developed by Michael D. Dake, MD, et al of the Working Group on Aortic Diseases of the DEFINE Project. The approach, called the DISSECT classification system, was published in the European Journal of Vascular & Endovascular Surgery (2013;46:175–190).

According to the investigators, 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 problem.

In recognition of the expanding range of interventional therapies now used as alternatives to conventional treatment approaches, the DEFINE investigators developed a categorization system that features the specific anatomic and clinical manifestations of the disease process that are most relevant to contemporary decision-making.

As summarized in the European Journal of Vascular & Endovascular Surgery, the DISSECT classification system guides clinicians through an assessment of six critical characteristics to 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 that make up DISSECT 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.

The DEFINE Project investigators stated that 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 the new DISSECT system for categorization of aortic dissection addresses the shortcomings of well-known established schemes devised more than 40 years ago, before the introduction of endovascular techniques. The investigators concluded that 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.