Thoracic Aortic Dissection

The aorta is the main blood vessel that carries blood from the heart to the rest of the body. The aorta has a thick wall that is made of three different layers of tissue, so it can withstand the high pressure that is generated when the heart pumps blood to the body. It extends from the chest to the lower abdomen,where it branches into the iliac arteries. The iliac arties carry blood to the lower parts of the body and to the legs through the femerol arteries.

Sometimes with aging or other changes, a section of the aorta may weaken and tear, causing the layers of the aorta to come apart. This tearing and separation in the layers of the aorta is called a dissection. Sometimes a dissection occurs in the part of the aorta that runs through the chest. This is called a thoracic aortic dissetion.

Acute (recent) aortic disscetion is a potentially life-threatening condtion. It requires  prompt and accurate diagnosis immediately after symptoms appear in order to get the right treatment.When an aortic dissection has been present for a long time period, it is called a chronic aortic dissection.

Symptoms of aortic dissection typically occur soon after the tear develops and can vary from one patient to the next. The most common symptom of thoracic aortic dissection is chest pain. Sufferers describe a very sharp or tearing pain in either the front or back of their chest, most often between the shoulder blades.The pain occures suddenly, and is commonly described as one’s “worst  pain ever”.

Once diagnosed ,thoracic aortic dissection should be treated promptly.The two main complication are rupture of the aorta or maloerfusion(reduced blood flow from blockage of critical aoritc branch arteries that supply blood to importamnt organs such as kidneys and gut)and both need prompt treatment.There are three types of treatment for thoracic aortic dissection. Medical management, open surgical repair and endovascular repair. At Acadiana Vascular Clinic we do all three.

All patients will recieve medical management, or medications that help control heart rate and blood pressure.

Surgical reapir, is surgery to repair the section of the aorta that has a dissection.To reach the dissection, the doctor makes a cut through the breastbone or the side of chest. The doctor repairs the aorta by replacing the disscetion section with a fabric tube called a graft. Patients usually stay overnight or several days in intensive care unit, and stay another seven to ten days in hospital.

Endovascular repair is relatively new treatment. Endovascular means “inside or within a blood vessel”. The doctor makes a small incision near the hip to get to the  femoral arteries. Though these small incisions, an endovascular graft is inserted into the femoral artery and possitioned inside the aorta. The graft seals off the area where the tear in the aorta begins and makes a new path through which the blood flows. This procedure usually takes one to three hour to complete. Patient may have a hospital stay of only a few days. Then can usually return to normal activity within four to six weeks after the procedure. Recommended  follow-up includes checkups at one month, six months , twelve months  and yearly thereafter.

If you have any questions or concerns about thoracic aortic dissectionand treatments.Please feel free to contact our office.


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