Having Aortic Dissection is a serious medical condition that requires the attention of a cardiologist. This condition can lead to a number of complications. These include: (a) Symptoms – This condition can cause pain, breathing difficulties, and shortness of breath, and may lead to fainting. (b) Treatment – There are several different treatments for Aortic Dissection. These treatments include Endovascular stent grafting, surgery, and medication.
Diagnosis
Detecting the diagnosis of aortic dissection can be challenging because there are no classic findings. However, it is important to diagnose the disease as soon as possible to minimize the risk of acute aortic insufficiency and other grievous complications. In addition, prompt diagnosis is necessary for choosing the most appropriate surgical or medical interventions. The incidence of aortic dissection is relatively low, ranging from five to thirty cases per million people per year.
Aortic dissection is caused by excessive degeneration of the extracellular matrix in the aorta. Patients with arterial hypertension are at increased risk. This condition can trigger the development of a proinflammatory state that results in excessive extracellular matrix degeneration. Aortic hypertension can also induce the recruitment of macrophages. This can lead to thrombus formation in the false lumen.
Diagnosis of aortic dissection is usually based on imaging techniques. X-ray computed tomography (CT) and two-dimensional transthoracic color-flow echocardiography are two standard imaging modalities for diagnosis. However, these methods are expensive and time-consuming. They may not be available in the point-of-care setting, making the diagnosis of aortic dissection difficult.
Angiography is another diagnostic tool. It is a noninvasive test that uses radio wave energy and a magnetic field to produce images of blood vessels. It is highly sensitive but can be difficult to perform in a critical setting. Angiograms can identify the entry and re-entry sites and determine the extent of the dissection. Angiography is usually preferred by surgeons prior to repair.
Diagnosis of aortic disease is also possible with easily accessible blood tests. This can make monitoring patients easier and more cost-effective.
However, aortic dissection is often associated with a high level of morbidity and mortality. This is partly due to a delay in diagnosis. This is because patients with aortic dissection are often at risk for other less serious etiologies. Aortic dissection can occur with a variety of presentations, including nonspecific chest pain and severe back pain.
Patients can also have a rapid, weak pulse. Patients with aortic dissection may experience difficulty swallowing pressure on the esophagus. This can also lead to vomiting, nausea, and fainting. Aortic dissection is a medical emergency and people with aortic symptoms should go to the emergency room.
Complications
Several different types of complications can arise from aortic dissection. These include blood leakage, organ damage, and aortic rupture. In addition, patients can experience sudden shortness of breath, chest pain, and fainting. Fortunately, the majority of people with aortic dissection can be treated and live normal, fulfilling lives. However, complications can be serious, and early detection can save lives.
The causes of aortic dissection vary depending on where it occurs in the body. Most commonly, dissection occurs in the ascending aorta. However, dissections of the descending aorta can also occur. When dissection of the ascending aorta is discovered, doctors usually recommend surgical repair. In addition, drugs are administered to reduce blood pressure and limit the spread of the dissection.
If an aortic dissection involves the aortic root, the patient may experience symptoms similar to ST-elevation myocardial infarction. Patients also have the chance of experiencing a stroke, kidney failure, limb ischemia, and intestinal ischemia.
The onset of symptoms of aortic dissection usually occurs in the fifth decade of life. Patients may experience chest pain, shortness of breath, and tearing sensations. The pain can also radiate to the neck and back. A patient may also experience numbness or inability to move their legs.
Aortic dissection can cause aortic rupture, which can lead to death. This is especially dangerous if the rupture occurs in the pericardial space. If it does, the patient may experience cardiac tamponade. The rupture may also cause internal bleeding.
Depending on the type of dissection, patients may need a number of tests. These include computed tomography, magnetic resonance imaging, and blood tests. These tests are used to determine the cause of the dissection and to determine the treatment plan.
Drugs are usually administered intravenously to reduce blood pressure and heart rate. Some patients may also require a stent graft. These grafts are less invasive than open surgery and lower the risk of complications.
Some people with aortic dissection may not experience pain. This can make it difficult to distinguish the pain from a heart attack. In addition, the pain can be difficult to differentiate from other diseases.
Treatment
Several conditions can lead to aortic dissection, including atherosclerotic disease and connective tissue disorders. Symptoms may include shortness of breath, low blood pressure, chest pain, tearing, and a stabbing or ripping feeling. Aortic dissection can be life-threatening and requires immediate intervention. The mainstay of treatment is surgical repair.
Aortic dissection is rare, occurring in about 30 people per million. It’s most common in people aged 50 and older. It can occur anywhere along the aorta. It’s caused by the rupture of an intima (the thin layer of tissue separating the aorta from the media), which can be caused by an injury, or by a preexisting degeneration of the aortic media.
Aortic dissection can cause severe internal bleeding and may result in aortic regurgitation. It may also lead to organ ischemia, heart failure, or stroke. It may also result in bleeding out of the aorta, leading to aortic rupture. The goal of surgery is to restore normal blood flow and prevent the progression of the dissection.
People with aortic dissection will need regular medical follow-up and monitoring. In addition, they may be prescribed blood pressure medications, including beta-blockers. This medication will control blood pressure and is usually used in conjunction with other drugs. It may also be used to lower blood pressure before surgery.
People with aortic dissection may also need regular imaging, including MRI scans. These images can help doctors determine the condition of the aorta and determine if it needs to be repaired. The patient may also need to be admitted to an intensive care unit for further monitoring.
People with aortic dissection are at high risk for a stroke because the blood in the aorta can cause severe pressure on the heart. They may also have aortic regurgitation, which causes muffled heart sounds. Aortic dissection is also more common in men than women. The incidence increases in men older than 40.
The mortality rate for aortic dissection is 90% at one year and 30% at one week. The rate of aortic dissection is highest in patients with hypertension, a connective tissue disorder, or African ancestry.
Endovascular stent grafting
Currently, stent grafting for aortic dissection is a relatively new surgical procedure that offers a non-surgical alternative to surgery. Stent grafts are a tube composed of fabric and metal mesh, and they are usually placed inside the aorta to strengthen it and prevent aneurysm formation. They are placed using X-ray guidance and they are held in place by metal hooks.
Patients are usually treated with open surgery, but endovascular stent grafting is an alternative for patients with uncomplicated type B dissections. Stent grafts are placed within the aortic true lumen to prevent aneurysm formation. Endovascular stent grafting is performed in a cath lab by vascular surgeons.
The endovascular stent grafts are custom designed for each patient. They are opened up inside the aorta, and they are held in place with metal hooks. The aortic diameter is never larger than before stent-grafting deployment.
The average time between diagnosis and stent-grafting placement was a little less than 13 days. The early mortality rate was 16 percent. Patients who died had events occurring within 30 days of stent-graft placement. Other complications include leaking blood around the graft, kidney injury, and paralysis.
The majority of patients had aneurysms that were no longer ruptured. There was no difference in the aortic-related mortality rates between the two groups. However, the rate of adverse neurologic events was higher in the endovascular group. The primary entry tear was covered by the stent graft, but further evaluation is needed to determine the therapeutic potential of this approach.
The study was approved by an institutional review board. The study included 19 patients who had an aortic dissection and underwent stent-graft placement over the primary entry tear. Patients were included if they had a history of hypertension and a primary entry tear less than 20 mm from the left subclavian artery.
Patients underwent an arteriographic examination to evaluate clinical symptoms and signs of dissection. They were also tested for infra-diaphragmatic visceral ischemic complications. They were then ruled out if they had aortic branch vessel compromise.
All patients were followed up by CT and intravascular ultrasonography to evaluate flow in the aortic lumen. They also underwent balloon fenestration of the dissection flap. The average follow-up period was 13 months.
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