What is aortic dissection?

Aortic dissection is a tear or partial tear in the inside layer of the largest blood vessel in the body, the aorta. This tear allows blood to pass through the artery wall. Over time, this continuous flow can cause the aorta to break (this could cause sudden massive internal bleeding) - a condition that most people do not survive.

There are two types of aortic dissections, although sometimes both conditions occur:

• Type A: Dissection of the part of the aorta leading upwards from the heart. These dissections can be treated with medications (usually only for a short time), with catheterization, or with surgery.
• Type B: Dissection of the part of the aorta that leads down (descending aorta) into the abdomen (stomach). These dissections are most often watched and treated with medications. Surgery may be done, but there is risk of paralysis.

What are the warning signs and symptoms of aortic dissection?

Aortic dissections are usually found in people with high blood pressure or arteriosclerotic vascular (all blood vessels outside of the heart) disease. It may also occur in persons with a family history of aortic (or thoracic) dissection and sometimes associated with congenital (present at birth) cardiovascular disorders (Marfan's syndrome, Ehlers-Danlos syndrome, and congenital valvular disorders). Aortic dissection is more common in men than in women.

"Stabbing" pain in the back is a common symptom of an aortic dissection. In some cases, people have pain in the chest. This pain may be confused with chest pain (known as angina and is a warning sign of a possible heart attack). The main difference between pain from dissection of the aorta, and angina due to lack of blood supply to the heart muscle, is its sudden and intense onset. The pain of dissection is often described as a "ripping" or "tearing" sensation. This sudden pain can be felt in the back, chest, neck, or jaw. A cold sweat may go along with the pain. As the dissection worsens, the location of the pain may move.

It is important to be aware of the difference between angina and pain due to aortic dissection... Why? Because common advice to those with angina or "chest pain" (that may result in a heart attack) is to chew an aspirin to thin the blood. This is NOT the case if your symptoms are due to an aortic dissection. Thinning the blood for a person with aortic dissection may cause more blood to leak out of the aorta. This internal bleeding can lead to death.

In some cases, people do not feel any pain. Instead, one may have the following symptoms:

• Confusion (due to lack of blood supply to the brain)
• Numbness or tingling sensation in the arms or legs (due to lack of blood supply to the spinal cord)

If you or someone you know is having any of the above symptoms, call 9-1-1 immediately to get to a hospital. The survival rate increases greatly the sooner a person is treated for an aortic dissection.

How is an aortic dissection detected?

The key to diagnosing an aortic dissection is to prove that it is in fact a dissection and not a heart attack. Treatment will depend on which type of dissection it is.

The usual test for diagnosing aortic dissection is a computed topography (CT) scan. More tests may be needed to determine the type and location of the dissection. These include:

• Echocardiogram (ultrasound)
• Magnetic resonance imaging (MRI)
• Peripheral angiography (a dye study)

What is the treatment for an aortic dissection?

There are three types of treatment for an aortic dissection: 1) medical treatment, 2) interventional catheterization, and 3) surgery. Your doctor will decide which treatment is best, depending on where and how bad the dissection is.

A small percent of cases (5 - 10%) are Type B dissections (dissections of the descending aorta). This condition can be treated with surgery, but it is risky. Typically, the doctor will watch the situation closely and prescribe medications to control the dissection.

The methods used to treat dissections are as follows:

• Medical Treatment: Medicine is given to lower blood pressure and cholesterol, and to stop plaque build-up.
• Endovascular Intervention: This procedure requires small incisions in the groin. Small wire-like, catheter devices called endoluminal stent grafts are threaded to the site of the dissection. These devices have a woven artificial graft tip, which is positioned at the area of dissection and left in place. This provides a channel for blood to flow freely, repairing arterial leakage, and preventing pressure from rupturing the aorta. This procedure is much less invasive than the usual open surgery. A hospital stay of about 2-3 days is needed and a recovery time of a couple of weeks. Please note: This procedure can only be performed in certain situations.
• Open Surgery: This surgery requires opening the chest to remove the dissected aorta. An artificial graft is sewn in its place for blood to flow freely to the rest of the arteries. This surgery requires a hospital stay of a week or more, and recovery can take 6-8 weeks.

6/16/2008