In this Article

• Introduction to aortic dissection
• What are the causes of aortic dissection?
• What are the signs and symptoms of aortic dissection?
• How is aortic dissection diagnosed?
• What is the treatment for aortic dissection?
• What is the prognosis for aortic dissection?
• Can aortic dissection be prevented?
• Aortic Dissection At A Glance
• Aortic Dissection Glossary
• Aortic Dissection Index

What is the treatment for aortic dissection?

The ABCs of resuscitation are always a priority.

In the emergency department, intravenous lines will be placed, monitors for heart rate and rhythm will be attached, and supplemental oxygen provided. Treatment and diagnostic testing usually occur at the same time until the final diagnosis is established.

The initial medications used are directed at lowering the blood pressure to prevent further tearing or damage to the aorta. Beta blocker medications [for example, esmolol (Brevibloc), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol XL)] decrease the adrenaline action on the heart and blood vessels. Nitroglycerin dilates blood vessels to decrease blood pressure. Specific medication combinations will depend upon the patient's needs.

Ultimately, type A aortic dissections of the ascending aorta require surgery as the treatment of choice. The area of aorta that is damaged is replaced with an artificial graft. If the aortic valve has been damaged, it too may need replacement or repair.

Medical management (non-surgical) is preferred for Type B dissection of the descending aorta, but again, each patient needs to be assessed individually as to the specific treatment suggested. Medications are prescribed to aggressively control high blood pressure to prevent further dissection and aortic injury.

What is the prognosis for aortic dissection?

For aortic rupture, in which all three layers of the aorta are disrupted, the mortality (death) rate is up to 80% of patients. Fifty percent of these patients die before reaching a hospital.

For Type A aortic dissection, the mortality rate remains high, with up to a 30% death rate after surgery.

Type B aortic dissections, treated medically, have an initial death rate of 10%. This compares to a 30% mortality when treated surgically.

Overall, for both types of aortic dissection, the ten year survival rate is more than 60%