Aortic Dissection

What is it?

Dissection tear

  • An aortic dissection is a tear in the inner wall of the aorta, the main blood vessel that travels from the heart. When this tear occurs, blood can flow within the layers of the aortic wall causing the aorta to become weak and potentially altering the perfusion of blood downstream. These life-threatening effects can lead to aortic rupture or malperfusion of end-organs (brain, kidneys, intestines, etc.). Aortic dissections are classified as either type A or Type B: 
  • Type A: Occurs in the ascending aorta and/or aortic arch with possible extension into the descending thoracic aorta
  • Type B: Occurs in the descending thoracic and/or abdominal aorta only

Causes & Risk Factors

The exact cause of aortic dissection is still unknown, but there are several associated risk factors including:

  • High blood pressure
  • Genetic disorders that effect connective tissue such as Marfan Syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome
  • Aortic Inflammation (Aortitis)
  • Atherosclerosis
  • An existing aneurysm
  • Congenital anomalies ( bicuspid aortic valve or aortic coarctation)
  • Trauma

Symptoms

The most common symptom of an aortic dissection is severe, constant, ripping/tearing chest pain that may migrate to the upper back.

Diagnosis

In addition to your physician getting your complete medical history and doing a physical exam, they may order any of the following tests:

  • Computed tomography (CT) scan
  • Transesophageal echocardiogram (TEE)

Treatment

In most cases, an aortic dissection is a life-threatening emergency and immediate treatment is needed. All patients require medications to lower the blood pressure in order to decrease the force of blood against the aortic wall. The decision to treat an aortic dissection with surgery is a complicated one and depends on multiple factors including:

  • Type of dissection (Type A vs Type B)
  • Malperfusion of end organs (intestines, kidneys, etc.)
  • Diameter of the aorta
  • Persistent chest pain
  • Refractory high blood pressure

If requiring surgery, a Type A dissection typically requires an open operation where the surgeon replaces the diseased portion of aorta with a synthetic tube. The aortic valve may also need to be replaced.
If requiring surgery, Type B dissections often can be treated with thoracic endovascular aortic repair (TEVAR) whereby a stent-graft is deployed through minimally invasive means into the aorta.

Regardless if treating an aortic dissection with medications or surgery, it is critical that all patients undergo long-term monitoring with serial CT scans as the aorta is at high risk to degenerate (become aneurysmal) over time.