An aortic dissection, also known as a dissecting aneurysm, occurs when a tear develops in the aorta (largest artery in the body). The flow of blood causes separation of the layers of the aorta which may lead to rupturing of the aortic wall or compromise of blood flow to various organs. Complications can lead to kidney failure and other organ damage, stroke, aortic valve damage, paraplegia and even death.
The two types of aortic dissection are:
- Type A – The most common type. Occurs when the tear involves the part of the aorta closest to the heart. The tear may extend further down-stream to involve other parts of the aorta as well.
- Type B – Occurs when the lower aorta tears, and can also extend into the abdomen.
Risk factors for aortic dissection include:
- High blood pressure
- Atherosclerosis (hardening of the arteries)
- Aortic coarctation (narrowing of the aorta)
- Bulging arteries
The best way to prevent aortic dissection is to monitor and reduce high blood pressure. Quitting smoking, maintaining a healthy diet and preventing traumatic injuries are also ways to reduce risk of aortic dissection.
Certain genetic diseases also have a high risk factor, such as:
- Marfan syndrome – Condition when the connective tissue is weak and are prone to tears and aneurysms.
- Turner syndrome – Affects only females and is a result of having a missing or incomplete sex chromosome.
- Loeys-Dietz syndrome – Disorder characterized by twisted arteries.
- Ehlers-Danlos syndrome – Condition in which skin easily bruises or tears apart.
Other risk factors include being a male between a male between the age of 60-70, using drugs and being pregnant.
Symptoms of aortic dissection are similar to someone experiencing a heart attack. These include:
- Chest and upper back pain
- Shortness of breath
- Loss of vision
- Weak pulse
The most common ways to diagnose aortic dissection includes using different types of imaging procedures such as:
- Computerized Tomography (CT) Scan – A machine scans the chest and generates X-rays to produce images of the chest. Iodine may be injected into the body to make the heart and blood vessels visible in the images.
- Magnetic Resonance Angiogram (MRA) – A magnetic field and radio wave energy produces pictures of the blood vessels in the chest.
- Transesophageal Echocardiogram (TEE) – A test that uses high-pitched sound waves to produce images of the heart.
Treatment for aortic dissection may include surgery or medications.
- Medication – Most people with type B aortic dissection require medication like beta blockers and vasodilators to reduce blood force on the aortic wall. Medication to lower blood pressure may also need to be taken chronically.
- Type A Aortic Dissection – As this is the most common and life-threatening type of aortic dissection, surgery is the preferred treatment. Surgeons remove most of dissected aorta and block the entry of the blood into the aortic wall. A synthetic tube (graft) is used to reconstruct the aorta. If the aortic valve also needs to be replaced, it is also reconstructed with a graft.
- Type B Aortic Dissection – Patients with type B aortic dissection can be treated with the same type of graft reconstructive surgery as Type A patients. More commonly, wire mesh tubes (stents-grafts) can also be used to repair the aorta through the groin.
As with all surgeries, patients should have regular follow up with CT or MRI scans.