Thoracic aortic dissection
| Aortic dissection | |
|---|---|
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| Dissection of the descending part of the aorta (3), which starts from the left subclavian artery and extends to the abdominal aorta (4). The ascending aorta (1) and aortic arch (2) are not involved. | |
| Specialty | Vascular surgery, cardiothoracic surgery |
| Symptoms | severe chest or back pain, vomiting, sweating, lightheadedness |
| Complications | Stroke, mesenteric ischemia, myocardial ischemia, aortic rupture |
| Usual onset | Sudden |
| Risk factors | High blood pressure, Marfan syndrome, bicuspid aortic valve, previous heart surgery, major trauma, smoking |
| Diagnostic method | Medical imaging |
| Prevention | Blood pressure control, not smoking |
| Treatment | Depends on the type |
| Prognosis | Mortality without treatment 10% (type B), 50% (type A) |
| Frequency | 3 per 100,000 per year |
| Classification |
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| External resources |
Aortic dissection occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In most cases this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. Also, vomiting, sweating, and lightheadedness may occur. Other symptoms may result from decreased blood supply to other organs such as stroke or mesenteric ischemia. Aortic dissection can quickly lead to death from not enough blood flow to the heart or rupture of the aorta.
Aortic dissection is more common in those with a history of high blood pressure, a number of connective tissue diseases that affect blood vessel wall strength such as Marfan syndrome, a bicuspid aortic valve, and previous heart surgery.Major trauma, smoking, cocaine use, pregnancy, a thoracic aortic aneurysm, inflammation of arteries, and abnormal lipid levels are also associated with an increased risk. The diagnosis is suspected based on symptoms with medical imaging such as computed tomography, magnetic resonance imaging, or ultrasound used to confirm and further evaluate the dissection. The two main types are Stanford type A which involves the first part of the aorta and type B which does not.
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