An aortic dissection is a tear in the inner layer of the vessel wall of the aorta, which leads to a splitting of the vessel wall. This creates a "true" and a "false" lumen (channel). Depending on the localisation of the tear, aortic dissections are divided into type A and type B according to the Stanford classification.
Type A aortic dissection is a cardiac surgery emergency and is treated by our colleagues in cardiac surgery. In the following, we will therefore only discuss type B aortic dissection in more detail.
In most cases, the cause of such a tear in the vessel wall is high blood pressure, which is why it is very important to adjust the blood pressure.
Symptoms
The main symptom is the sudden onset of annihilation pain, which is often localised between the shoulder blades.
In many cases, however, the symptoms are not clear and depend on the affected vascular segment. If the carotid arteries are blocked, symptoms of a stroke may occur. If the abdominal arteries are affected, acute abdominal pain may occur; in the case of spinal arteries, acute paraplegia may occur; in the case of renal arteries, renal failure may occur; and if the lower main artery is completely blocked, a reduced supply to the lower extremities may occur.
Diagnostics
The gold standard for diagnosing aortic dissection is computer tomography with contrast medium (CT angiography).
Therapy
In the case of an uncomplicated aortic dissection, priority is given to controlling the blood pressure with medication. In the acute phase, this is initially carried out on a monitoring ward. In addition to blood pressure control, regular CT checks with contrast medium (CT angiography) are necessary.
In the case of a complicated aortic dissection, i.e. persistent pain, non-adjustable high blood pressure or circulatory disorders of extremities and/or organs or an increase in the size of the vessel diameter, surgical treatment is necessary. In this case, minimally invasive (endovascular) procedures by implanting a stent prosthesis in the main artery to close the tear are sought.
