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Aortic dissections can occur in any section of the thoracic aorta, which includes the aortic root, ascending aorta, aortic arch, or proximal descending aorta. The dissection (tear) creates a false channel (lumen) that allows blood to flow through the middle (medial) layer of the aorta. The false lumen can extend throughout the thoracic and abdominal aorta, and can compromise the flow of blood in the true lumen. This causes a lack of blood flow to particular organs and a significant weakening of the aortic wall. A possible complication is a rupture of the aortic dissection - a life threatening event. Risk factors for developing an aortic dissection include: atherosclerosis, uncontrolled hypertension (high blood pressure), smoking and some genetic disorders.
An aortic dissection can be categorized as an "Acute Aortic Dissection" or a "Chronic Aortic Dissection," which is dependent upon when the initial tear occurred.
- Acute Aortic Dissections are defined as dissections that occur within two weeks of the initial event. Depending on the patient's current medical condition, the physician may recommend immediate surgery, as acute dissections are more likely to lead to rupture.
- Chronic Aortic Dissections are defined as dissections that are persistent for more than two weeks following the initial event. Patients with chronic dissections can experience chest, back or abdominal pain, or be asymptomatic. Chronic dissections are closely monitored to track the growth rate of the aorta.
Aortic dissections can be classified by the location of the tear. There are two types of aortic dissections:
- Type A Aortic Dissections involve the ascending aorta and usually requires emergency surgery. They are likely to be seen in patients with a history of elevated blood pressure, an ascending aortic aneurysm, connective tissue disorder, such as Marfan Syndrome, bicuspid aortic valve, or a family history of aortic dissections.
- Type B Aortic Dissections do not involve the ascending aorta, and therefore usually involve the aortic arch, descending or abdominal aorta. Patients with Type B Aortic Dissections can present with elevated blood pressure and a history atherosclerosis and cigarette smoking. These types of dissections may be managed conservatively with blood pressure and heart rate control. Your physician will consider the location of the dissection, the risk of rupture, symptoms and the ability to manage blood pressure when deciding on surgical or medical treatment options.
Aortic Dissections: Signs & Symptoms
Signs and symptoms depend on the location and whether the dissection is acute or chronic. If an aortic aneurysm dissects, the patient usually experiences severe sudden pain. Signs and symptoms of aortic dissection may include any of the following:
- Severe sharp chest, back, or abdominal (stomach) pain.
- Cough or blood in sputum
- Heart murmur (abnormal changes in heart sound)
- Trouble breathing which may be affected by position
- Trouble swallowing
- Wheezing (high-pitched noise when breathing)
- Dizziness or Confusion
Aortic Dissection: Non-Surgical Treatment Options
- Watchful Waiting: "Watchful waiting" is commonly recommended for a patient whose aneurysm is small and asymptomatic. In such cases, the physician will keep a close watch on the patient's condition with periodic CT or MRI scans, blood pressure control,treatment ofhigh cholesterolif indicated. Our patients receive life-long management with annual follow-up even after surgery
- Medication: You may be given medicine to slow the growth of your aortic aneurysm and decrease the risk of rupture. If the patient has hypertension, the physician may prescribe a blood pressure medication in order to reduce strain on the weakened portion of the aorta. A cholesterol-lowering medication such as a "statin" may also be prescribed. Recent advances have demonstrated that in certain, limited situations, medical management may in fact reverse the growth process.
The complex nature of aortic disease and significant variations in presentation of individual patients requires a multidisciplinary approach that is unique and individualized and includes all aspects of surgical technique and lifelong medical treatment.
We provide surgical and medical consultation to review specific treatment strategies on a collaborative basis that will help confirm and characterize the aortic disease process in combination with optimal medical treatment and establish a surgical threshold.