Aortic Dissection: How It’s Treated

Dr. Bernardo Mendes, a vascular/endovascular surgeon, and Dr. Peter Downey, an adult cardiac surgeon, discuss how aortic dissection is treated at the UCLA Aortic Center.

What is aortic dissection?

Today, we’re going to talk about aortic dissection and how it can be treated.

The aorta is the largest blood vessel in the body. It carries blood from the heart through the chest and abdomen to the rest of the body. The wall of the aorta is made up of three layers.

An aortic dissection occurs when the inner layer of the aortic wall tears. Blood then enters the wall of the aorta and separates its layers, creating a false channel for blood flow. This can reduce blood flow to vital organs and may weaken the aortic wall, increasing the risk of rupture.

Aortic dissections often occur in areas of weakened aortic tissue. Risk factors can include aortic aneurysms, high blood pressure, and certain inherited conditions that affect the connective tissue of the aortic wall.

An aortic dissection is a serious medical emergency and often requires urgent treatment.

What are the steps in treating aortic dissection?

The first step is making the diagnosis, usually with imaging such as a CT scan. Once the diagnosis is confirmed, a specialized team is assembled to determine the best treatment approach.

For some dissections, particularly those involving the descending thoracic or abdominal aorta, we can often use minimally invasive endovascular techniques. Through small access sites in the arteries of the legs, we guide specialized stent grafts into the aorta and position them across the tear. This helps restore normal blood flow and reinforce the damaged section of the aorta.

Other dissections, especially those involving the ascending aorta near the heart, usually require emergency open surgery. These procedures are often lifesaving.

During open repair, we remove the damaged portion of the aorta and replace it with a durable synthetic graft. We use specialized techniques to protect the heart, brain, and other organs while the repair is performed.

These operations typically take between four and eight hours. Most patients spend time in the intensive care unit afterward and remain in the hospital for about a week, although recovery times vary depending on the complexity of the repair.

If you have been diagnosed with an aortic aneurysm or have undergone treatment for an aortic dissection, talk with your doctor about your options. You can also contact the UCLA Health Aortic Center to learn more about available treatments and ongoing care.

How Is an Aortic Dissection Treated?

An aortic dissection is a serious medical emergency. It happens when a tear forms in the inner layer of the aorta, the body's largest blood vessel. Blood can then flow into the wall of the aorta, causing the layers to separate.

Treatment depends on where the tear occurs and whether it is causing complications.

Emergency Treatment

All patients with an aortic dissection need immediate medical care in an intensive care unit (ICU).

The first goal is to reduce stress on the aorta and prevent the tear from getting worse. Doctors do this by:

• Closely monitoring blood pressure and heart rate
• Giving medications through an IV to lower blood pressure
• Giving medications to slow the heart rate
• Treating pain, which can raise blood pressure and put more stress on the aorta

Type A Aortic Dissection

A Type A dissection affects the first part of the aorta, closest to the heart.

This type is usually treated with emergency surgery because it can quickly become life-threatening. Without surgery, the risk of death increases with each passing hour.

During surgery, the damaged section of the aorta is removed and replaced with a synthetic graft. In some patients, the surgeon may also need to repair or replace the aortic valve or other nearby portions of the aorta.

Type B Aortic Dissection

A Type B dissection affects the descending aorta, the portion that travels through the chest and abdomen.

Many patients with an uncomplicated Type B dissection can be treated with medications alone. The goal is to keep blood pressure and heart rate under good control while the aorta heals.

If complications develop, such as poor blood flow to important organs, ongoing severe pain, uncontrolled blood pressure, or bleeding, a procedure may be needed.

In many cases, doctors can place a stent graft through a blood vessel in the groin. This minimally invasive procedure helps reinforce the damaged area of the aorta and improve blood flow.

Long-Term Follow-Up

Even after successful treatment, patients need lifelong follow-up because the aorta can change over time.

Most patients will:

• Take blood pressure medications every day
• Have regular CT or MRI scans to monitor the aorta
• Avoid smoking
• Work with their doctors to reduce their risk of heart and blood vessel disease

Regular checkups and imaging tests help doctors detect problems early and keep patients healthy for the long term.

Key Takeaway

An aortic dissection is a medical emergency. Type A dissections usually require emergency surgery, while many Type B dissections can be treated with medication unless complications occur. Careful long-term follow-up is important for all patients with aortic dissection.

References:

Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A Jr, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Dec 13;80(24):e223-e393. doi: 10.1016/j.jacc.2022.08.004. Epub 2022 Nov 2. PMID: 36334952; PMCID: PMC9860464.

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