Hello everyone and welcome back to another day of #AorticDiseaseAwareness month! Today I would like to start with a small challenge! Without peeking, can you remind me the name of those three layers of the aorta that we discussed earlier in the month? Comment your answers below.
Those layers are important to remember as today we will be dicussing aortic dissections. For more information, be sure to follow along in pages 13-23 of your patient guide for more information.
An aortic dissection refers to a tear within the innermost layer of the aorta, causing blood to rush and accumulate between the innermost and middle layer. The “dissection” refers to a visual splitting of the aorta, creating a true and false lumen. The true lumen is where we want blood to flow, the false lumen is a second unnatural entry that blood should not be going to.
(Page 14, Aortic Dissection: The Patient Guide)
There are two main types of aortic dissections groups, depending on where in the aorta they occur:
Type A dissections are more dangerous, occurring in the upper “ascending” part of the aorta; sometimes they extend downwards to the abdomen.
The treatment for type A aortic dissections will almost always require emergency surgery to help replace the torn aorta and restore blood flow to the rest of the body.
Depending on the extent of your dissection, your surgeon may perform a hemi-arch repair, where they replace the ascending part of your aorta only or a total arch repair (with or without an elephant trunk) to help repair more extensive dissections.
(Page 16, Aortic Dissection: The Patient Guide)
(Page 17, Aortic Dissection: The Patient Guide)
Type B dissections involve a tear in the lower (descending) aorta. The ascending part of the aorta is not affected.
Type B dissections can usually be managed medically at initial diagnosis as long as bloodflow to your abdominal organs and limbs is unaffected. Sometimes, your surgeon may place an endovascular graft into your descending aorta to help reinforce your aorta, expand the true lumen and cut off blood supply to your false lumen.
This can be made by small cuts made in your groin and will often not require a full surgical cutdown.
(Page 18, Aortic Dissection: The Patient Guide)
Diagnosis of a dissection requires some sort of imaging of the aorta. CAT scans are considered the gold standard test for aortic dissections as they allow clinicians to visualize the ENTIRE aorta which is useful for distinguishing between type A or type B dissections. Additionally, your doctor may order contrast to help distinguish between the true and false lumen and to check for organ perfusion.
Conversely, an echocardiography may help show aortic dissections in unstable patients who cannot withstand a CT machine, but will not provide as high quality images. Additionally certain parts of the aorta (distal ascending aorta/arch) are hard to visualize on echo.
Here at Aortic Hope, we strive to be aware of the early symptoms of an aortic dissection. These may be common presenting signs to facilitate early medical intervention:
Sudden shooting chest or upper back pain, spreading to the neck or down the back
Sudden stomach pain
Fainting / loss of consciousness
Shortness of breath
Sudden vision problems
Sudden
Difficulty speaking
Weakness / loss of movement (paralysis) on one side of body
Weak pulsation in one arm or leg compared with the other
Pain in lower extremities
In addition, be sure to familiarize yourself with some common risk factors of aortic dissection such as:
Male gender
Old age
High blood pressure
Hardening of the arteries (atherosclerosis)
Bicuspid aortic valve
Turner syndrome
Connective tissue disease (Marfan syndrome, Ehlers Danlos Syndrome)
Pregnancy
Intense weight lifting
Smoking
Family history
As always, our family at Aortic Hope thanks you for being on this journey with us. Be safe and happy and remember to always Think Aorta! See you soon.
Adham
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