Reviewed By: Pramod Kerkar, MD, FFARCSI

Aortic dissection is a situation that occurs due to rush in the flow of the blood because of a tear in the aortic intima. There is a separation of the intima and the media, which creates a false lumen or channel. The damage in the aortic intima can be primary or secondary to the occurrence of a hemorrhage. It is possible for the dissection to appear at any point through the aorta and extend its presence across other arteries. The primary contributor to the extension of the dissection is hypertension.

What is the Survival Rate Of An Aortic Dissection?

According to statistics, at least 20% of the patients die before they reach the hospital. Additionally, the absence of the treatment leads to 3%/h mortality rate within the first 24 hours. It increases to 30% in a week, 80% in two weeks, and 90% in a year.

Doctors classify aortic dissection anatomically, which are as follows:

Type I (50% dissection) – such dissections occur in the ascending aorta and tend to spread to the surrounding regions such as the aortic arch and even beyond.

Type II (35% dissection) – such dissections occur only in and around the ascending aorta with proximity to innominate artery.

Type III (15% dissection) – such dissections start from the descending aorta that is present to the left of the subclavian artery and spread proximally.

The above system, known as DeBakey classification system is in extensive use, although there is another classification system called as the Stanford System. The following is the Stanford System:

Type A – dissections involve aorta

Type B – dissections include descending aorta.

The Origin

The origin of a dissection occurs due to an increase in the hydraulic stress. Therefore, it is possible for the appearance of an aortic dissection anywhere through the aorta. The high hydraulic stress regions are:

  • The ascending wall of the aorta present to the right that is 5cm from the aortic valve
  • Away from the origin of the subclavian artery.

Symptoms and Signs

One of the primary symptoms that the individual experience is the interscapular pain, often defined as ripping, which occurs abruptly. The pain that started at the origination slowly begins to move along with the extension of the dissection towards the aorta. If the body is already suffering from hypertension, then the situation can be dangerous, as it results in bleeding.

Occasionally, people suffering from myocardial infarction, stroke, renal insufficiency, and paraparesis, show the signs of an aorta dissection due to a blockage of the supply of the blood to the vascular bed, which includes the brain, spinal cord, heart, extremities, intestine, and kidneys. The obstruction is due to the development of the false channel in the aorta.

Diagnosis

It is possible to identify the presence of the illness with the help of TEE (Transesophageal echocardiography), CTA (computed tomography angiography), and MRA (magnetic resonance angiography). Before proceeding with the treatment, the doctor will consider additional factors such as the presence of the chest pain, thoracic pain, unexplained syncope, stroke, unexplained abdominal pain, and an unequal blood pressure in the limbs.

Treatment

Depending on the state of the dissection and its location, the physician will advise the use of beta-blockers and a few other medicines depending on the overall health of the patient to control hypertension. In extreme conditions, the physician will consider a surgery that involves endovascular repair.

Doctors shift a patient into an ICU who still possess the time for recovering from an aortic dissection. The medical management begins immediately to ensure that the blood pressure is at a compatible rate.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: February 3, 2018

This article does not provide medical advice. See disclaimer

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