Acute aortic dissection is by definition an intimal tear (tear in the aortic lining) which occurs in ascending, aortic arch or proximal descending aorta creating a false channel that allows blood to enter into the media layer of the aorta (middle layer of the aorta). The blood can pass through either the true or false channel therefore the aortic lumen has two openings or passage ways. Arteries that originate from the aorta (see anatomy page) may receive blood from either the true, false or both lumens. However, the false channel can compromise the flow of blood in the true lumen and cause a lack of blood to a particular organ. The false channel can extend throughout the entire length of thoracic and abdominal aorta. Once a dissection occurs the strength of the aortic wall is significantly decreased. A possible complication of aortic dissection is rupture. For the first two weeks, the aortic dissection is categorized as acute however after two weeks it ís classified as chronic. During the chronic phase patients are followed carefully to track the growth rate of the aorta.
General Considerations:
Medical therapy involves antihypertensive medication, and beta-adrenergic antagonist and/or angiotensin inhibitors (angiotensin converting-enzyme inhibitors or angiotensin-II receptor antagonists) are generally favored in these cases, but evidence that they actually reduce the rate of aortic expansion has this far been generated only for patients with connective tissue diseases.
Most patients should be managed with a Beta-blocker which may have some benefit for aortic aneurysm stabilization. Blood pressure monitoring is crucial in the medical management of patients with aneurysms. Aneurysm-related pain is commonly seen in patients with uncontrolled blood pressure. Likewise, uncontrolled high blood pressure predisposes one to acute aortic dissection.
In addition to medical therapies, smoke cessation and a modest exercise program is recommended. Excessive straining from heavy weight lifting is not recommended. Limiting yourself to less than or equal to 20 lbs is probably acceptable.
The following are general guidelines that need to be individualized to the specific patient and circumstance. There are various clinical and radiologic variables that need to be considered prior to making any recommendations for any type of intervention. Only at very specific clinical scenarios are interventions urgent for the management of thoracic aortic diseases. Most patients need serial imaging and medical management prior to making a recommendation for surgery.