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Aortic Dissection is a Serious Condition That Can Lead to Instant Death
June 24, 2016

Fernando Fleischman, M.D.To get more insight into what happens when you get an aortic dissection and how to prevent one, we turned to Fernando Fleischman, MD, assistant professor of surgery and the co-director of the USC Comprehensive Aortic Center at Keck Medicine of USC.

The aorta is the main artery of the body that supplies oxygenated blood to the circulatory system. It passes out of the heart from the left ventricle and runs down in front of the backbone. Dr. Fleischman explains that an aortic dissection is a tear in between one of the three walls of the aorta. 

When this happens, blood enters an area where it should not. This is usually caused by high blood pressure. High blood pressure is considered anything above 130.

This is a deadly problem, the patient is at risk of having their aorta get bigger and/or rupture, which leads to death.

Anyone Can be Affected
  • Aortic dissections affect people of all ages, but are most common among people in their mid 30s to late 80s.
  • Many people are under the impression that dissections are related to heart disease, but they are not.

 

Aortic Dissection with Stanford and DeBakey classifications - treatment and surgery, Los Angeles, California

How aortic dissections are classified

The Stanford System classifies aortic dissections based on whether the ascending aorta is involved.

  • Stanford Type A (Ascending Aorta) - Type A dissections come right out of the heart. The tear from Type A dissections can cut off the coronaries — the arteries that surround and supply the heart. It can also cause a stroke and cut off the carotids (the two main arteries that carry blood to the head, neck and brain and their two main branches).
  • Stanford Type B (Descending Aorta) - Type B dissections are descending thoracic aorta dissections. The thoracic aorta is the part of the aorta located in the thorax. Type B dissections can get aneurysmal, which is when the artery becomes excessively enlarged due to the weakening of the artery wall. They can also cut off blood flow to vessels of the abdomen or legs. They can also become big and risk rupturing, which causes death.

The DeBakey System classifies aortic dissections based on the location of the original intimal tear:

  • DeBakey Type I – originates in ascending aorta, and propagates at least to the aortic arch and often beyond it distally. It is most often seen in patients less than 65 years of age and is the most lethal form of the disease.
  • DeBakey Type II – originates in the ascending aorta and is confined to it.
  • DeBakey Type III – originates in the descending aorta and rarely extends proximally, but will extend distally. It most often occurs in elderly patients with atherosclerosis and hypertension.
After diagnosis

If a patient is diagnosed with an aortic dissection, they have likely been admitted into an emergency room. Following an aortic dissection, the patient only has a couple hours to live, so action needs to be taken immediately.

The USC CardioVascular Thoracic Institute at Keck Medicine of USC has a rapid transport system that brings patients to our facilities quickly. We handle more aortic dissections than any other medical enter in Southern California and are staffed with a fantastic team.

Type A dissections require a major operation. The patient needs to be cooled down to prevent any blood flow and the cardiac surgeon has to replace the actual aorta with a plastic tube so blood can go back to the brain.

Type B dissections are handled with a team approach. If the dissection happens before the artery branches off, it can be treated with a stent, which is a round device that diverts blood flow within the artery and other blood pressure controls. The other option is medical therapy, which is why a team approach is necessary.

How to prevent an aortic dissection

Manage your blood pressure. To manage your blood pressure, it is recommended to diet and stay away from foods with high sodium.

When to get checked:

We recommend for you to visit a physician if you have:

  • A family history of aneurysm or dissections
  • Blood pressure above 130 that has been uncontrolled for years
  • High blood pressure and chest pain of any kind
  • Smokers who have a history of aneurysm and now have chest paint

Aortic dissections can be prevented if patients maintain their blood pressure and if they have aneurysms, to have them watched by our team. Once an aneurysm gets to a certain size, it has a higher risk of rupture. Our goal is to meet with and advise these patients early, so we can monitor their ascending aortas.

To learn more about the USC Comprehensive Aortic Center, visit http://aortic.keckmedicine.org/. To schedule an appointment, call (800) USC-CARE (800-872-2273) or visit http://aortic.keckmedicine.org/request-an-appointment/.

Related page: Aortic Dissection

 

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