Aortic Dissection

Aortic Dissection is a medical emergency in which there will be a tear in the wall of the main artery of your body.

Some facts about Aortic Dissection:

• Aorta is the main artery of your heart that sends blood from your heart to the rest of your body. Blood will get in between the three layers of aorta because of the tear reducing the amount of oxygen and nutrients available for the organs of your body.
• The tear can affect your brain, lungs, arms, legs, and heart, overtime depending on the location of the tear.
• Treatment also depends on the location of tear. Surgery is the most likely option if the tear is on the ascending aorta which is the part of the aorta that goes up through your chest toward your head.
• High blood pressure, injury from an accident, genetic conditions that are passed down in families, structural heart problems and smoking are some of the risk factors for aortic dissection.
• Although Aortic Dissection is uncommon, it is most frequently in men aged 60 to 70 when it occurs.
• Chance of survival greatly improves when an aortic dissection is detected early and treated promptly.
• When the tear originate in the aorta where it exits the heart, or as a tear extending from the upper to lower sections of the aorta, it is called as Type A which is the more common and dangerous dissection type.
• In Type B, the lower aorta is only involved, from where the tear originates and that may extend into the lower abdomen.
• The risks of aortic dissection repair include stroke, heart attack, lung infections, bleeding, risks from anesthesia and death. However, may also have other risks depending on your specific medical condition.
• You should discuss any concerns with your healthcare provider before Aortic Dissection.

Types of Treatments:

• Patients are treated immediately because of the potentially fatal nature of aortic dissection.
• The blood pressure and heart rate will be reduced by providing certain medication.
• Drug therapy alone may be used if the dissection is small, else a surgery is performed.
• Damaged sections of the aorta are removed and a synthetic graft is often used to reconstruct the damaged vessel in surgery.
• The aim of the surgery is to remove the most severely damaged segments of the aorta, and to eliminate the entry of blood into the tear.
• The damaged section can be replaced with a tube graft when there is no damage to the aortic valve.
• A stent graft such as in TEVAR (thoracic endovascular aortic repair) can be inserted in addition to the on-going medical management.
• The damaged section of aorta can also be replaced with a sutureless vascular ring connector-reinforced graft which  is a titanic ring used as a stent in the vascular graft to achieve a quick, blood-sealed, and sutureless connection.

Preparation for Aortic Dissection:

• You won’t be able to prepare for it in advance as you need emergency surgery for an aortic dissection.
• However, if possible, you should inform your healthcare provider if you are allergic to any medicines or have any loose teeth, bridges, crowns, or other types of dental work.
• All the medicines you take including over-the-counter, prescription medicines as well as vitamins, herbs, and other supplements should be informed to your healthcare provider as some could cause too much bleeding or other problems during surgery.
• Other instructions will be provided by your healthcare provider for you based on your medical condition.

Procedure for Aortic Dissection:

• A general anesthesia will be given to you to prevent pain and put you to sleep during the procedure.
• Your vital signs, like your heart rate and blood pressure will be will carefully watched by your healthcare provider during the procedure.
• An incision will be made in your chest or abdomen by your surgeon for a traditional open-heart surgery. The exact spot will depend on the location of your dissection.
• You will be connected to a heart bypass machine which will take over pumping blood around your heart and lungs.
• The damaged parts of the aorta will be replaced by synthetic grafts once the tear is found by your surgeon. A replacement valve will also be inserted if your aortic valve is damaged.
• Your incision will be closed and heart bypass machine will be removed once your surgeon has made all of the repairs
• A synthetic graft will be attached to the end of a catheter by your surgeon for the endovascular method. The graft can be made of either metal and polyester.
• The catheter will be placed into an artery in your leg by your surgeon.
• The surgeon will thread the graft through your artery, to the affected part of the aorta for the repair using X-ray images as a guide.
• The best placement of the graft and its correct position can be found by using a X-ray dye.
• The catheter will then be removed and the incision will be closed by your surgeon. A small bandage will be put on the wound.

Recovery of Aortic Dissection:

• It may take a few months to fully recover from your surgery.
• You will be in the intensive care unit (ICU) until your vital signs are stable and then will be moved to the regular nursing floor to continue your recovery before going home.
• You may need medicines for nausea, pain, and discomfort during your hospital stay.
• You will likely have to take blood pressure medicine as high blood pressure puts stress on the incision wall and on your heart.
• You may also need to take blood-thinning medicine to reduce your risk for blood clots if your surgery included a valve replacement.
• Recovery time is less for endovascular surgery compared to traditional open-heart surgery. However, you may need to follow up with your provider every six months as there is a risk of blood leaking from the graft.