Aortic Dissection

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Treatment

Aortic dissection is a medical emergency that must be treated immediately. The goal of treatment is to minimize complications. Initial treatment may involve intravenous (i.e., through a vein; IV) blood pressure medications, usually administered in the intensive care unit (ICU) of a hospital.

Treatment options depend largely on what type of dissection has occurred. Patients with Stanford Type A dissections (i.e., in the ascending aorta) require surgery. Patients with Type B dissections that do not involve the ascending aorta may be treated with medication and consistent follow-up.

Surgery used to treat Type A aortic dissections depends on the patient's symptoms, on the location and severity of the dissection, and on how treatment may affect blood flow in other areas of the body.

In some cases, surgeons replace the ascending aorta. In this procedure the dissected area is removed, the blood flow is diverted away from the aortic wall, and the aorta is reconstructed using grafts made of a special composite material. Mesh tubes (called stents) may be placed in the aorta to keep the artery open and allow blood to flow more freely.

Coronary bypass surgery may be performed when aortic dissection affects arteries in the heart (coronary arteries). If the dissection has damaged the aortic valve, treatment may involve surgery to replace the valve.

Type B dissections may be managed with medications. In most cases, patients must take blood pressure medications (e.g., beta blockers) for the remainder of their lives. By lowering blood pressure and reducing heart rate, beta blockers may help prevent the aorta from tearing further. Sometimes, physicians prescribe pain relievers as well. Definitive treatment for type B aortic dissections is not always clear, and in some cases, surgery may be required.

Follow up
It is extremely important for patients who experience aortic dissection to follow up with their physicians regularly. Heart rate and blood pressure must be closely monitored and medications often must be adjusted. Some patients have equipment to monitor blood pressure at home.

Patients also must undergo regular follow-up CT scans and/or MRA scans to make sure that the aorta is still functioning well, that no further damage has occurred, and that surgical grafts or stents are still effective. These tests should be conducted every 3–6 months for the first year or 2, and then annually. In some cases, follow-up surgery is necessary.

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