Aortic dissection

An aortic dissection represents a serious and often critical condition in which there is a progressive tear in the innermost layer (tunica intima) of the aorta, the largest artery in the body. This tear allows blood to flow between the layers of the aortic wall, forcing the layers apart.

Aortic dissection of DeBakey type I

Pathophysiology

In an aortic dissection, blood penetrates the intima and enters the tunica media, the middle layer of the aortic wall. This leads to the formation of a "false lumen," a new, abnormal channel within the aortic wall. The process can progressively extend along the length of the aorta, potentially interfering with the branches of the aorta and leading to a range of complications.

Dissecting aneurysm 01

Risk Factors

Key risk factors for aortic dissection include uncontrolled high blood pressure (hypertension), conditions that cause inflammation of the arteries (like vasculitis), certain genetic disorders such as Marfan syndrome, and a history of heart surgery or procedures. Aging, smoking, high cholesterol levels, and a family history of the condition also contribute to the risk.

Clinical Presentation

Symptoms of an aortic dissection can mimic those of other conditions, making it challenging to diagnose. The most common symptom is severe, sudden chest pain often described as tearing or ripping, radiating to the back. Other symptoms may include shortness of breath, loss of consciousness, weak or absent pulse in one arm, or leg pain or paralysis.

Diagnosis

Diagnosis is often made based on clinical signs and symptoms, and is confirmed by imaging studies, such as computed tomography (CT) angiography, magnetic resonance imaging (MRI), or transesophageal echocardiography.

Treatment

The treatment for aortic dissection depends on the location and extent of the dissection. Type A dissections, which involve the ascending aorta, are typically treated with emergency surgery due to their high risk of complications. Type B dissections, which occur distal to the subclavian artery, can often be managed medically with blood pressure control, although surgery may be needed in certain situations.

Prevention

Preventive measures for aortic dissection largely involve managing risk factors. This includes controlling hypertension, treating conditions like vasculitis, and monitoring those with genetic conditions like Marfan syndrome. Additionally, individuals with a history of aortic dissection may require regular follow-up imaging to monitor the aorta.

References

1. Nienaber, C. A., & Clough, R. E. (2015). Management of acute aortic dissection. The Lancet, 385(9970), 800-811.
2. Ramanath, V. S., Oh, J. K., Sundt, T. M., & Eagle, K. A. (2009). Acute aortic syndromes and thoracic aortic aneurysm. Mayo Clinic Proceedings, 84(5), 465-481.

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