Treatment of aortic dissection depends upon the location of the tear.
Type A Aortic Dissection: This type of tear is located closer to the heart and can be life-threatening. It usually requires urgent surgery to repair or replace the first segment of the aorta (ascending aorta) where the tear started. The risk of dying from this urgent surgery is about 10 to 20 percent, depending on the condition of the patient at the time of arrival.
Type B Aortic Dissection: This type of tear is located further down the aorta (descending aorta), further from the heart, surgery may not be necessary initially, but intensive medical therapy for blood pressure control is paramount. These patients are first managed using intravenous blood pressure medications and close, careful monitoring. The need for surgical intervention may then be delayed for a matter of months to years depending on the severity of their tear. The exception occurs in patients where the downstream tear cuts off blood flow to the vital organs including the kidneys, intestines, legs or even the spinal cord. Like dissections that occur close to the heart, these patients require urgent intervention to save their lives.
What are the types of treatment for aortic dissection?
Surgery and Endovascular Treatment
Depending on the extent of aorta involved, a durable repair may require open surgery where the aorta is replaced with a fabric tube called a graft that is directly sewn in place of the diseased aorta. Alternatively, the surgeon may use a stent graft which is a fabric tube supported by metal wire stents (like a scaffold) to repair the aorta. The stent grafts are delivered “endovascularly” which means they are placed over a wire through a small incision in the groin and then delivered upstream into the aorta and deployed by releasing the stents like a spring.
Another option that is commonly required in patients with aortic dissections is a hybrid approach, utilizing a combination of conventional open surgery and endovascular stentgraft techniques. One of the most common hybrid procedures is called the “elephant trunk” procedure. During this procedure an open operation is performed to repair the aorta close to the heart, as well as the aortic arch – the segment of the aorta where the blood supply to the brain originates. In addition to this, an additional graft is left hanging into the descending, or downstream aorta, like the trunk of an elephant. This elephant trunk provides a durable place to land an endovascularly placed stent graft during an additional procedure. Newer hybrid procedures involve surgery and reconstruction of the aortic arch blood vessels without the use of the heart lung machine in combination with stent grafts to repair complex aortic dissections in the chest.
Medications, such as beta blockers are prescribed to lower heart rate and blood pressure . In addition other medications may be used.