Dr Jason Toniolo

Aortic dissection

Aortic dissection is a complicated condition that requires a long conversation about its implications and cannot easily be explained through website content delivery.

An aortic dissection is a tear in the inner layer of the aorta, causing blood to flow between the layers of the aortic wall causing a life-threatening emergency.

Risk factors for dissection

  • Males are 5x more likely to have a dissection than females
  • Age > 50
  • Chronic high blood pressure
  • Bicuspid aortic valves (anatomical abnormality with which you are born)
  • Connective tissue disorders – Marfans, Ehlers-Danlos, Loey-Deitz, and familial thoracic aneurysmal disease
  • Cocaine use

Symptoms:

Sudden, severe chest or upper back pain, often described as tearing or tearing, is common.

More rare symptoms that indicate a complication of the dissection include

  • Numbness or weakness in the legs (or, infrequently, hands)
  • Flank pain
  • Abdominal pain and nausea
  • Stroke – rare
  • Collapse

Complications caused by aortic dissection

  • Loss of blood to the heart (ascending aortic dissections)
  • Loss of blood supply to the brain (stroke – again, ascending aortic dissections only)
  • Loss of blood supply to the spinal cord
  • Loss of blood supply to the kidneys, intestines, or legs
  • Rupture of the aorta (massive bleeding)
  • Aneurysmal degeneration of the aorta (long-term)

Treatment for dissection

Not all dissections require surgery, but all dissections require hospitalisation and medicine with serial scans to check for changes.

Medical management

Aortic dissections require urgent medical attention. Treatment involves medications to lower blood pressure and heart rate, usually performed in the intensive care unit. Sometimes, depending on your dissection type, you may or may not also require surgery.

Type A dissection surgery

Dissections that begin at the beginning of the aorta as it exits the heart are called ‘type A’ dissections and require immediate surgery to prevent death. Cardiothoracic surgeons perform this operation.

Type B dissection surgery

Vascular surgeons repair type B dissections that occur slightly further along the aorta after the vessels to the brain and arms come off the aorta. They are best managed with medicine in the hospital, with surgery reserved for patients who have problems getting blood to their legs or organs. Some patients are candidates for surgery after a few weeks from when their dissection occurs to prevent problems years later with their aorta. The surgery used for type B dissections is a large fabric-lined stent. Some patients also require a bypass or additional stents to maintain flow to their left arm and brain.

Dr Jason Toniolo

Comprehensive range of conditions

Aortic dissection is a complicated condition that requires a long conversation about its implications and cannot easily be explained through website content delivery.

An aortic dissection is a tear in the inner layer of the aorta, causing blood to flow between the layers of the aortic wall causing a life-threatening emergency.