Aortic Dissection
Aortic Dissection:
A Life-threatening Condition with Poor Clinical Outcomes
Aortic dissection is a tear in the inner layer of the aortic wall that creates a new channel for blood flow. As blood flows through this ‘false lumen’, normal blood flow to other parts of the body will slow or stop. Aortic dissection can be life-threatening if not identified and treated quickly.
There are two types of aortic dissection
Type A
Type A, the more common form of aortic dissection, involves the ascending aorta and may progress to the thoracoabdominal aorta. Type A dissections are a life-threatening condition which may cause the aorta to rupture,
potentially leading to sudden cardiac death. If left untreated, the mortality rate is 25% at 6 hours, 50% at 24 hours, and nearly 70% within 1 week.2
2. Erbel et al., Eur Heart J. 2014;35(41):2873-926.
Type B
Type B dissections are classified as hyperacute, acute, subacute, and chronic when relating to the time since onset of symptoms. Type B dissections are also classified according to their acuity as complicated, high-risk, or uncomplicated dissections.3 Complicated dissections are associated with rupture or reduced blood flow to vital organs, while patients with high-risk dissection present different clinical or imaging symptoms putting them at high-risk of early or late complications. Evidence accumulates that such patients require immediate intervention via open or endovascular surgery.
Current treatment options for Type B aortic dissection (TBAD) include surgical replacement or an endovascular stent graft. Both treatment options bring procedural complexity and are associated with 15-50% mortality rate,4 a rate of approximately 15% of neurological complications,6 in particular permanent paraplegia,7 and a reoperation rate often greater than to 15%.2,4-7
2. Erbel et al., Eur Heart J. 2014;35(41):2873-926 3. Lombardi et al. J Vasc Surg 2020;71:1077-87 4. Kenneth et al. Comprehensive Vascular and Endovascular Surgery (Second Edition), 2009 5. Bavaria et al. Ann Thorac Surg 2015;100:802–9 6. Cambria et al. J Vasc Surg 2015;62:271-8 7. White et al. J Vasc Surg 2011;53:1082-90
30%mortality rate
15%risk of paraplegia
15%reoperation rate
