What are the classifications of aortic dissection zones?

Aortic Dissection Zone Classification

The aortic dissection zone classification system divides the aorta into 11 distinct landing zones (Zones 0-11) that precisely define anatomic segments from the ascending aorta through the iliac arteries, primarily used for endovascular repair planning and risk stratification. 1

The 11-Zone Landing System

Arch and Proximal Zones (0-2)

• Zone 0 extends from the ascending aorta to the distal end of the innominate artery origin 1
• Zone 1 spans from the innominate artery to the origin of the left common carotid artery 1
• Zone 2 extends from the left common carotid to the origin of the left subclavian artery 1

Descending Thoracic Zones (3-5)

• Zone 3 encompasses the proximal descending thoracic aorta (first 2 cm distal to the left subclavian) down to the T4 vertebral body 1
• Zone 4 extends from the end of Zone 3 to the mid-descending aorta at T6 level 1
• Zone 5 spans from the mid-descending aorta to the celiac artery 1

Abdominal Zones (6-9)

• Zone 6 extends from the celiac artery to the superior mesenteric artery, involving the celiac origin 1
• Zone 7 spans from the superior mesenteric artery to the renal arteries, involving the SMA origin 1
• Zone 8 extends from the renal arteries to the infrarenal abdominal aorta, involving the renal artery origins 1
• Zone 9 encompasses the infrarenal abdominal aorta to the level of aortic bifurcation 1

Iliac Zones (10-11)

• Zone 10 involves the common iliac arteries 1
• Zone 11 involves the origin of the external iliac arteries 1

Clinical Significance and Application

This zone classification is fundamentally different from the Stanford and DeBakey dissection classifications—it serves as an anatomic roadmap for endovascular intervention planning rather than a pathologic classification system. 1

Key Clinical Uses

• Endovascular repair planning: The zone system allows precise communication about proximal and distal landing zones for thoracic endovascular aortic repair (TEVAR) 1
• Risk stratification: More proximal zones (especially Zone 0) carry significantly higher procedural risk and mortality compared to distal zones 2
• Surgical decision-making: Zone involvement determines whether arch debranching or other adjunctive procedures are necessary 1

Important Caveats

• Zone 0 has been further subdivided in recent literature into 0A (annulus to distal margin of highest coronary), 0B (above coronary to distal margin of right pulmonary artery), and 0C (right pulmonary artery border to innominate artery), with Zone 0A disease predicting significantly worse outcomes 2
• The zone system does NOT replace Stanford or DeBakey classifications for initial diagnosis and management decisions—Stanford Type A versus Type B remains the primary determinant of surgical versus medical management 1, 3
• Zone involvement directly impacts stroke risk: More proximal landing zones (0-2) require coverage of arch vessels, necessitating revascularization procedures and increasing neurologic complication rates 1