Aortic dissections are a complex group of conditions that require expert care and management. Broadly, aortic dissections occur when the layers of the aorta (the main artery of the body, which arises from the heart and travels through the chest into the abdomen) separate. Dissections can form from diseased vessel walls and severely elevated blood pressure. Arteries have three parts to the wall: the inner, middle and outer parts. Dissections occur when the inner section is torn and blood flows from inside the vessel lumen out and between the inner and middle layers. This injury results in separation of the vessel wall and is associated with sudden onset severe tearing back or abdominal pain.
Aortic Dissection Signs and Symptoms
People with an aortic dissection may experience a variety of symptoms. The most common effects are:
- Sudden, ripping pain in the chest and or back
- Shortness of breath
- Sudden weakness
Aortic Dissection Risk Factors
Common risk factors for aortic dissection include:
- High blood pressure (hypertension)
- A major chest injury, such as an auto accident
- A hereditary connective tissue disorder (e.g., Ehlers-Danlos syndrome, Marfan's syndrome)
- Nearing the end of a pregnancy
- Untreated syphilis
Types of Aortic Dissection
Aortic dissections are classified based on the part of the aorta involved. If the first part of the aorta is involved, this is known as the ascending aorta dissection or a Stanford type A dissection. If the dissection involves the aorta as it descends the chest and abdomen, this is known as a descending aortic dissection or Stanford type B dissection.
Stanford type A dissections are largely treated using open, surgical techniques as this is a life-threatening condition. Stanford type B dissections can also be life threatening, but this condition can vary in severity. Rapid diagnosis is critical. Once diagnosed, the goal is to prevent further tearing and separation of the vessel wall. This goal can be accomplished by controlling blood pressure and the heart rate. If the dissection or tear continues or worsens, critical blood flow may be reduced to the extremities and vital organs. This scenario requires expert care and expeditious treatment to avoid death.
Aortic Dissection Treatment
Mount Sinai offers both endovascular and open surgical treatments for this complex condition. Endovascular treatments include placing a stent graft similar to that used during endovascular aneurysm repair seal off the tear in the inner aortic wall. This treatment may help prevent the tear from worsening.
In addition to stent-grafting, we utilize advanced technologies, such as endovascular ultrasound, to help facilitate these advanced repairs. Additionally, we offer novel treatments, including endovascular fenestrations, to minimize the damage our internal organs caused by these dissections when definitive care is not possible. Aortic dissections are cared for by a multidisciplinary team of cardiac and vascular surgeons in order to offer the best possible care.
Monitoring Aortic Dissections
Once a dissection is diagnosed, treated and stabilized, strict monitoring is needed. Aortic dissections can progress to aneurysms. Similar to native aneurysms, these aneurysm can rupture and can be life threatening. Utilizing similar endovascular treatments to those applied to abdominal aortic aneurysm and thoracic aortic aneurysm, these aneurysms can often be treated using minimally invasive procedures. When these minimally invasive treatments cannot be applied, complex open surgical repairs can be lifesaving as well.
Division of Vascular and Endovascular Surgery
Vascular Interventions – Cardiac Cath Lab
1190 Fifth Avenue, 1st Floor
New York, NY 10029