How is aortic dissection treated?

How is aortic dissection treated?

Treatment of aortic dissection depends upon the location of the tear and dissection. Immediate surgery is needed for Type A aortic dissection (i.e., when it involves the first part of the aorta close to the heart). Type B aortic dissection requires emergency surgery if the dissection cuts off blood flow to your vital organs including your kidneys, intestines, legs or even your spinal cord. Urgent surgery is needed if there are certain high-risk features noted on CT scan imaging. Less severe cases may be treated with medication initially, delaying surgery until complications develop.

Surgery and Endovascular Treatment

Surgical options include:

• Graft replacement: With this approach, a portion of the damaged section of the aorta is removed and a synthetic fabric tube (graft) is sewn directly in its place.
• Endovascular stent-graft repair: With this approach, a stent graft — a synthetic fabric tube supported by metal wire stents (like a scaffold) — is used to repair the aorta from within. Endovascular surgery involves making the repair inside your aorta. A small incision is made in your groin and a catheter, with the fabric-lined stent attached, is delivered and deployed into the aorta under x-ray guidance. At the repair site, the stent graft is released and — like a spring or umbrella — opens up, relining and providing reinforcement to the weak area in the aorta.
• Hybrid approach: With this approach, a combination of conventional open surgery and endovascular stent-graft technique is used to repair the aorta. This is used when the repair must extend into the aortic arch where branch vessels to the brain and arms arise. This may be performed during the emergency operation for Type A dissection or as a two-stage repair with a bypass from a vessel in the neck to help set up an endovascular repair for Type B dissection. One of the most common hybrid procedures is called the “elephant trunk” or “frozen elephant trunk” procedure. First, the segment of the aorta close to the heart as well as the aortic arch (the segment of the aorta that supplies blood to the brain) is replaced and repaired. An additional graft, or stent graft, is left hanging into the descending aorta, like the trunk of an elephant. The graft is ready to receive the endovascularly placed stent-graft when the second surgery is performed.

Medications

Medications, such as beta blockers, may be prescribed to lower heart rate and blood pressure. In some Type B aortic dissection cases, medication alone may be used to treat the dissection initially. Surgery may be able to be delayed for months to years depending on the severity of the tear and extent of dissection.