Aortic Dissection Dissection

What is aortic dissection?
Aortic dissection is a serious condition in which a tear develops in the innermost layer of the aorta, the large blood vessel that carries blood away from the heart to the body. Once there is a tear, blood flows between the three layers of the wall of the aorta. The force of the blood flow, and its weight cause the layers to separate (dissect). If this blood-filled channel bursts through the outermost wall of the aorta, death can occur.

What causes aortic dissection?
The tear occurs in an already-weakened area of the aortic wall. Chronic high blood pressure can stress the aortic tissue over time, making it more prone to tearing. You can also be born with a condition that involves a weakened and enlarged aorta, such as Marfan syndrome.

What are the risk factors of aortic dissection?
This condition is fairly rare. While anyone can develop it, aortic dissection usually occurs in men between 60 and 70 years old, or young males with Marfan Syndrome (a genetic defect).

What are the symptoms of aortic dissection?
Because these can be similar to those of other heart problems–such as a heart attack–there can be a delay in receiving the proper diagnosis. Typical symptoms can include:

  • Sudden, intense "ripping" or "tearing" chest or upper back pain that spreads to the neck or down the back
  • Fainting
  • Shortness of breath
  • Sudden difficulty speaking, loss of vision, weakness, or paralysis on one side of the body
  • Sweating
  • Much weaker pulse in one arm than the other

How is aortic dissection diagnosed?
A doctor may suspect aortic dissection if the patient has some or all of the following symptoms:

  • Sudden tearing or ripping chest pain
  • Widening of the aorta, shown on a chest X-ray
  • Blood pressure difference between right and left arms

If a patient has the above symptoms and the doctor suspects aortic dissection, imaging techniques are used to make a conclusive diagnosis. Here are the ones most often used:

  • Computerized tomography (CT) scan: A series of X-rays that produce cross-sectional images of the chest.
  • Magnetic resonance angiogram (MRA): This scan uses a magnetic field and pulses of radiowave energy to create pictures of the blood vessels of the chest.
  • Transesophageal echocardiogram (TEE): An echocardiogram test uses high-pitched sound waves to produce an image of the heart. A TEE is a type of echocardiogram in which an ultrasound probe is inserted down the throat close to the heart and aorta, and offers a picture of these two parts.

What are the treatment options for aortic dissection?
Important: An aortic dissection is a medical emergency that requires immediate treatment.

Most often, aortic dissection is treated with medication, blood pressure control and monitoring. If dissection enlarges or causes heart compromise, then surgery is indicated.

MINIMALLY INVASIVE TECHNIQUES

  • Endovascular Stent Graft for Aortic Dissection: An aortic stent graft is the most common treatment option for an aortic dissection. Through a small incision in the groin, a catheter device (a carrier) is threaded through the vascular system to the area of the aortic dissection. The device leaves behind a stent graft, which provides a channel for blood to flow freely, repairs the blood leakage and prevents pressure from rupturing the aorta. Hospital stay is 1-2 days.

OPEN SURGERY

  • Open Surgical Repair for Aortic Dissection: This traditional treatment involves opening the chest and removing the portion of the aorta where its layers have separated (dissected). A synthetic graft (tube) is sewn in place through which the blood can flow normally.

For more information or to make an appointment with a vascular surgeon at Mount Sinai Beth Israel, click here to fill out an appointment scheduling form. A staff member will get back to you within 48 hours to schedule an appointment.

For An Appointment Call

Thomas R. Bernik, MD
Endovascular and Vascular Surgery
212.844.5555

Robert J. Grossi, MD
Vascular Surgery
212.844.5559

Gary A. Gwertzman, MD
Vascular Surgery and Wound Care
718.677.0109

Stephen P. Haveson, MD
Vascular Surgery and Wound Care
212.844.1330

Jennifer Svahn, MD
Vascular Surgery (Venous Disease)
212.420.5648

Vascular Labs
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