Aortic Dissection

An aortic dissection is caused due to tearing in the inner lining of the aorta. This tear allows blood to flow through the walls of the aorta rather than remaining in the central channel i.e. lumen. There are two primary types of aortic dissection which are defined by their location. They are type A and type B
  • In Type A dissection there is tear which  begins in the ascending aorta and it progresses throughout the vessel. It often extends as far as the arteries in the leg.
  • In Type B dissection, The tear is located only in the descending aorta, but it may also extend into the abdomen.
The distinction between the two types is important, as it can help in the right management of the disease. Type A dissection requires immediate surgical treatment. It is necessary to prevent death from stroke, heart attack, congestive heart failure, or bleeding. Type B dissection is a medical condition which can be treated with aggressive control of blood pressure initially. In case of any further complications , additional treatment methods can be used.

Aortic dissection symptoms may simulate heart attack. Patients might think they are having a heart attack . Its various others symptoms are:

  • Shortness of breath
  • Inability to find a comfortable position
  • Stroke
  • Extreme anxiety
  • Weakness
  • Sudden and severe “tearing” or “crushing” pain between the shoulder blades or behind the sternum
  • Extremely high blood pressure
  • Loss of consciousness

Many acute and chronic complications are caused by Type A dissection if timely treatment is not done. Various complications that are caused by aortic dissection are:

  • aortic rupture can cause extreme blood loss
  • rapid heart failure due failure Aortic valve incompetence: 
  • loss of blood from the coronary arteries to the heart muscle causing a heart attack (myocardial infarction)
  • Cardiac tamponade: it is caused due to accumulation of blood in the pericardium (the sac that contains the heart) . This leads to an inability of the heart to pump blood.
  • interruption of blood flow to the brain may cause a fatal stroke

Malperfusion syndrome can also happen as a result of aortic dissection. This syndrome is caused due to the flow of blood in the walls of the aorta rather than flowing through the vessel itself. Because of this enough blood is not able to reach its intended destination. This can lead to organ failure and most frequently involved organs are kidneys and intestines. This may result in temporary or permanent kidney failure and intestinal injury, which requires extensive bowel resection.

Type A Dissection is an emergency that requires immediate medical attention. Early diagnosis and surgical intervention is necessary.

Multidisciplinary treatment approach gives excellent outcomes. It needs long-term follow up. When treating patients with type A dissection, antegrade selective perfusion is used to treat dissection. This provides enhanced protection of the brain. Valve sparing root replacements can be done in order to replace the entire ascending aorta without leaving behind any residual dissection.

Aggressive control of blood pressure is the goto treatment method for type B aortic dissections. this ensures the dissection will not progress. Surgery is typically performed on the patients who are suffering from complications like malperfusion syndrome or active hemorrhage. unacceptably high risks of paralysis, fatal hemorrhage and lung dysfunction are associated with Open surgical repair. Medical therapy provides palliative care and helps in controlling blood pressure and pain. However, it does not protect the patient from development of large aneurysms over time, kidney dysfunction, and death from aortic complications.

Minimally invasive repair is a new age treatment for type B aortic dissection. Endovascular stent grafting is a treatment of choice. In this a stent is Inserted through a catheter in the groin and these devices effectively close the dissected aorta thereby redirecting the flow of blood.