The aorta is the main vessel that carries blood from the heart to the rest of the body. Its a wall is made of 3 layers. An aortic dissection is a tear that occurs between the innermost and middle layers of the aorta. Aortic dissections occur in about 3 per 100,000 patients per year. Both men and women are affected. Aortic dissections can compromise blood flow to your heart, brain, kidneys, liver, bowels and limbs. This condition is called mal-perfusion syndrome. Aortic dissections can also cause your aorta to rupture, which may lead to life-threatening bleeding.
Symptoms
Some aortic dissections are asymptomatic and are discovered during screening for other conditions. The most common presentation is chest pain/back pain
Causes
- High Blood Pressure
- Smoking
- Genetic/Familial Disorders – Ehlers-Danlos Syndrome, Marfans Syndrome or Loews-Deitz Syndrome
Diagnosis
Diagnosis is made via different types of imaging tests. These can include an ultrasound of the heart (an echocardiogram or echo), MRI or CT scan.
Treatments
Treatment of aortic dissections depends on the type of dissection.
Type A (ascending) dissections involve the aorta in the front of the chest, right next to the heart.
- Emergency treatment is required because a heart attack is possible.
- Usually, treatment is traditional surgery involving opening the chest and repairing and/or replacing the torn aorta.
Type B (descending) dissections occur in the aorta elsewhere in the chest and abdomen.
- If you have no symptoms, you may not need treatment.
- If the dissection is long-standing it may cause an enlargement (aneurysm) of the aorta. Depending on the circumstances, minimally invasive stent-grafts or open surgery can be required.
- If you are experiencing a lack of blood flow to an organ or a limb or bleeding, emergency treatment is needed. Usually, treatment is an endovascular stent graft, a minimally invasive procedure to reline the torn aorta and repair the dissection.
Health Tips
- Have your blood pressure tested regularly
- If you have high blood pressure, follow your doctor’s instructions for managing it
- Avoid the use of recreational drugs
- Stop smoking
How can I ensure I get successful care for my aortic disease
Aortic aneurysms can be complicated or simple in shape and typically occur in older people with other health conditions. The decision of when and how to treat is based on an assessment of multiple factors. The appropriate choice of treatment for you as a patient is decided only after this assessment. The best doctor for your aneurysm treatment is one who has expertise in surgery AND stent graft procedures so that the correct choice can be made for you. The procedure should be done in a hospital with the facilities and experts for dealing with any kind of problems related to the heart, lungs and kidneys that patients with aneurysms are prone to suffer.
International Publications On Aortic Surgery by Dr Robbie George and Team
- An Endovascular Filter to prevent embolization during aortic stenting. Journal of Vascular Surgery 63(2): 548-51.
- Contemporary management of symptomatic primary aortic mural thrombus. Journal of Vascular Surgery. 2014 Sep 22. S0741-5214(14)01623-1. doi:10.1016/j.jvs.2014.08.057
- Endovascular Exclusion of Complex Post-Surgical Aortic Arch Pseudoaneurysm using Vascular Plug Devices and a review of Vascular Plugs. Perspectives in Vascular Surgery and Endovascular Therapy (July 2013, DOI: 10.1177/1531003513501203)
- Management of Symptomatic Thrombus in Non-Atherosclerotic/Non-Aneurysmal Aorta. Journal of Vascular Surgery Volume 57, Issue 5, Supplement, May 2013, Pages 43S
- Surgical and endovascular treatment of occlusive aortic syndromes. J Cardiovasc Surg. (Torino). 2013 Feb;54 (1 Suppl 1):55-69.
- Acute thrombosis of abdominal aortic aneurysm presenting with lower limb ischaemia. ANZ J Surg. 2011 Dec;81(12):945-6
