Dissection Aorta
Introduction
Aortic dissection is an emergency condition where the patient must be transferred immediately to a specialized aortic center. Aortic dissection occurs when a tear appears in the inner layer of the aorta. That is, the aorta, which constitutes the largest vessel of the body, tears at one or more points resulting in hemorrhage, which leads to the detachment (dissection) of the inner and middle tunica (layer) of the aorta.
Aortic dissection is relatively rare. It usually appears in men aged 60 and 70 years. The symptoms of aortic dissection can many times resemble those of other diseases, often leading to delays in diagnosis. However, when aortic dissection is detected in a timely manner and treated immediately, the survival rates of the patient increase significantly.
The timely early diagnosis of the disease
is very important
for the good outcome of the condition in both stages of the disease.
Aortic Dissection
The aorta is a vessel which consists of three tunicas. In some patients the middle tunica detaches from the outer tunica and the space that is created fills with blood. As a result, the aorta which is like a tube acquires two lumens, a true one which is the normal lumen before the appearance of the dissection and a false one. Due to the fact that the false lumen on the outside consists of only one tunica it can rupture more easily. On the other hand, the true lumen is compressed due to the fact that the false lumen fills with blood and can lead to various symptoms depending on the point of compression.
The main risks of an aortic dissection are ischemia from compression of the true lumen, increased blood pressure and rupture of the aorta.
Ποιες είναι οι επεμβατικές μέθοδοι χειρουργικής θεραπείας;
Therapeutic options
The main criterion for the type of treatment is the type of dissection. Type A dissections (i.e. dissections that involve the aortic arch) are considered emergency situations and require immediate cardiac surgery intervention. Type B dissections (i.e. dissections that begin after the aortic arch) are considered emergency situations and are initially referred to organized vascular surgery centers with access to a cardiac surgery clinic.
The decision of immediate or non-intervention in a type B dissection depends on the symptoms of the patient as well as certain imaging criteria within the framework of CT angiography. In cases of persistent arterial hypertension, ischemia or rupture, the patient requires immediate treatment which is minimally invasive due to modern endovascular methods. In case of absence of symptoms that endanger the life of the patient a monitoring protocol in the intensive care unit and repeated imaging of the aorta is followed, which is common in most aortic centers worldwide. At a second stage (at least 14 days) it is decided whether an endovascular intervention should be performed or not.
The role of the vascular surgeon
Type B aortic dissection which concerns vascular surgeons is one of the most difficult conditions due to the uncontrollable behavior of the dissection membrane. The minimally invasive endovascular repair requires great experience particularly regarding the restoration of perfusion of the splanchnic vessels. Our clinic has great experience in this specific condition both in its acute phase and in the treatment of aneurysms following a dissection that has become chronic.
