Affects Ascending Aorta and/or Arch, requires Emergency Surgery
Begins Beyond Brachiocephalic Vessels, surgical consultation with surveillance and medical management.
Thoracic aortic dissection (TAD) is a serious condition in which a small tear creates a separation of the aorta walls. As the tear becomes larger, it can lead to bleeding along the wall of the aorta and can create two channels, a true lumen and a false lumen. The two blood channels are separated by layers of tissue, which can cause malperfusion to organs as well as expansion and rupture of the aorta.
TAD can be rapidly fatal, as many patients are not diagnosed prior to arrival in the emergency room. It is the most common acute aortic condition requiring urgent interventional therapy. For this reason, it is very important to diagnose and immediately refer thoracic dissection patients to a comprehensive treatment center to prevent unnecessary death.
The complexity of aortic dissections often necessitates a multi-disciplinary approach to treatment.
Medical Management: For cases that not life initially life-threatening, dissections can be managed medically. The use of beta blockers as well as medicine to lower blood pressure are the most common medical treatment, as well as the use of narcotics or opiates for pain management.
If intervention is required, there are currently two types of treatment:
Open Surgical Treatment: To gain access to the aorta, a thoracotomy is performed and the largest possible portion of the dissected aorta is surgically removed, closing the false channel between the middle and outer layers of the aortic wall, and replacing it with a synthetic graft.
Endovascular Repair: This treatment involves a small incision in the femoral artery for exposure and the insertion of a catheter-based device to deploy a stent graft. Endovascular treatment in appropriate patients can significantly reduce procedure times, recovery time, blood loss, paraplegia risk and wound complications.
Signs and symptoms depend on the location and type of dissection
Symptoms may include:
Patients should be evaluated based on a complete history and physical examination. Further diagnostic tests to uncover TAD can included chest X-Ray, CT Scan, transesophageal and regular echocardiogram, and MRI.
Variables Predicting TAD Intervention and Treatment