An aortic dissection is a splitting (dissection) of the wall layers of the aorta. The aorta is the main artery that transports blood from the heart to the body. An aortic dissection causes blood to leak from the aorta into the spaces between the vessel walls. The symptoms depend on the location and extent of the dissection.
Further information on causes and treatment options as well as selected aortic dissection specialists can be found below.
A blood vessel is basically a tube through which blood flows. It is formed by the vessel wall. The wall of larger blood vessels consists of three layers of tissue lying on top of each other:
The cavity inside a vessel is called the lumen.
The vessel wall layers split when the inner layer tears but the outer layer remains intact. Blood then leaks from the lumen through the tear into the space between the two layers.
Due to the increased pressure in the aorta, more and more blood enters the intermediate layer. As a result, the layers diverge over long distances and can form an unnatural space between them. As a result, the actual lumen can become completely blocked.
The intima usually cannot withstand the high pressure and tears at another point. This allows the blood to flow back into the aorta.
Illustration of an aortic dissection with blood in the space between the aortic vessel wall © htcmed | AdobeStock
Arteriosclerosis and structural weakness of the media (media degeneration) are considered risk factors for the development of an aortic dissection. Such structural weakness is often seen in patients with congenital heart valve anomalies or connective tissue diseases. Corresponding diseases include Marfan syndrome or Ehlers-Danlos syndrome.
Other risk factors include advanced age and high blood pressure. Traumatic events can also be the cause of an aortic dissection, such as an injury to the vessel wall during a catheter examination.
The symptoms depend on the location and extent of the dissection. Some patients with chronic aortic dissection have no symptoms at all. In others, however, a rupture of the aorta can lead to sudden cardiac death in extreme cases.
Typically, an acute aortic dissection is characterized by a sudden, sharp, stabbing or tearing pain in the chest. It can radiate to the shoulder blades and back.
Depending on the section of the vessel affected, other symptoms may occur, such as
The loss of blood can lead to symptoms of shock, such as
Depending on the location of the tear and the extent of the bleeding, several categories can be distinguished. The DeBakey classification defines three types of aortic dissection:
A further development is the Stanford classification. It distinguishes only two types based on the localization of the entry:
The location of the tear is decisive for the risk to the patient and therefore for the therapy. For this reason, aortic dissection specialists mainly use the Stanford types to assess the disease.
If an aortic dissection is suspected, imaging procedures can show bleeding into the aorta. Initial indications can be
can provide initial indications. Transesophageal echocardiography (TEE, ultrasound examination via the oesophagus) enables a precise assessment of the aorta close to the heart and the descending aorta.
The Doppler technique also allows a distinction to be made between the normal and "false" lumen, and entry and re-entry can usually be detected. Contrast-enhanced computed tomography (CT) allows the extent and relationship of the aortic dissection to the neighboring vessels to be visualized. Magnetic resonance imaging (MRI ) is also a reliable method for diagnosing aortic dissection. Angiography (a method of imaging the vessels) can also provide important findings.
The location of the tear is decisive for the therapy.
An acute dissection of the Stanford A type must be considered an emergency and should be operated on as quickly as possible. The affected vessel section is usually removed and replaced with a vascular prosthesis.
The implantation of vascular prostheses in the aorta involves a relatively high risk for the patient. For this reason, a Stanford B-type dissection is initially treated with a wait-and-see approach. This means that the doctor observes the development of the dissection. Only if the situation deteriorates, for example in the event of
he initiates therapy.
Aortic dissection specialists use catheters to treat complications such as blocked vascular outlets. Stent implantation can be used to stabilize the vessel wall and, if necessary, an artificial re-entry can be created. This reduces the pressure in the "false lumen" and thus reduces the risk of rupture.
Drugs are used to treat the pain and lower the blood pressure.
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