Aortic Dissections

About

  • An aortic dissection occurs when a tear forms in the inner layer of the aorta, which is the main blood vessel in the body.

    This can be life-threatening, and is a medical emergency.

  • Aortic dissections are uncommon.

    They usually affect people in their 50s to 60s.

  • Risk factors for peripheral arterial disease include:

    • Hypertension (high blood pressure)

    • Being male

    • Pregnancy

    • Uncommonly, genetic conditions called the ‘aortopathies’, including Marfan syndrome, Loeys-Dietz syndrome, and vascular-type Ehlers-Danlos syndrome.

  • Aortic dissections result from a tear in the main artery of the body; the aorta.

    This tear allows blood to move under the inner layer of the aorta, which can narrow or block the arteries to organs such as the brain, intestines, spinal cord, or limbs.

    The risks of an aortic dissection include stroke, paralysis, bleeding, or complications from not enough blood to the organs.

    Aortic dissections are usually classified as “Type A” or “Type B”. The aortic tear in Type A dissections starts closer to the heart, while Type B dissections start further away from the heart (usually past where the artery to the left arm leaves the aorta).

    Type A dissections can also cause problems with the heart itself, and therefore have a much higher mortality rate than Type B dissections.

  • Symptoms may include:

    • Pain – described as tearing pain, usually in the chest, back or abdomen

    • Passing out

    • Lack of blood supply to organs such as the intestines, kidneys, spinal cord, or legs. This results in abdominal pain, or pain or loss of sensation in the arms or legs.

  • As aortic dissections are life-threatening, patients suspected of having an aortic dissection are sent straight to hospital.

    Assessment begins with a thorough discussion about your medical history, followed by a clinical examination.

    A CT scan with intravenous contrast is the best test for diagnosing an aortic dissection, and determining its extent.

    An MRI is occasionally used in patients who have had a dissection for a long time.

TREATMENT

How do you treat an aortic dissection?

The first step in treating an aortic dissection is reducing the blood pressure and heart rate, to reduce further damage to the aorta. This is done in ICU.

Almost all Type A dissections need open surgery by a cardiothoracic surgeon.

In addition to blood pressure and heart rate control, treatment options for Type B dissections include:

  • Endovascular surgery – also called ‘keyhole surgery’, this involves a small incision in the groin, a stent (a tubular metal frame covered in material) is used to re-line the aorta, so blood no longer enters the aortic tear. This is called a thoracic aortic stent. Uncommonly, other stents need to be placed in vessels that are also torn, or bypass operations (to divert blood to affected vessels) are performed in the neck, abdomen or legs.

  • Open surgery and then endovascular surgery – in some complex dissections, sometimes open surgery is required, before the above endovascular surgery is performed.

After the acute phase, occasionally dissections need to be managed in the following weeks, months or years.

When an aortic dissection first occurs, it is a medical emergency. As such, the treatment is often decided in hospital. We will discuss which treatment option may be most suitable for you, with consideration of your preferences and other medical factors.

Do I need to follow-up with my Vascular Surgeon after my dissection?

If you need an operation, Dr Shiraev will want to see you after your operation, to make sure you have recovered well, your wounds are healing, and answer any questions you may have.

Even if you do not require an operation, an aortic dissection will be something that will need monitoring long term. There is a risk that another dissection may occur elsewhere in the aorta, or the previous dissection may extend. This is due to the nature of your aorta, as if you’ve already had a dissection, your aorta is already fragile.

Also, some people who have a aortic dissection will then go on to develop an aortic aneurysm, as the dissected aorta becomes weak and enlarged. Approximately 40% of people will then need the aneurysm fixed.

This advice is general, and is not intended to replace a formal clinical assessment and discussion with a health professional.