Published: May 1, 2008
Updated: Aug. 17, 2010
Acute aortic dissection represents the most common aortic condition requiring urgent surgical therapy. It occurs as a tear in the innermost layer of the aortic wall, causing blood to flow between the layers.
Typical symptoms of acute aortic dissection include abrupt onset of chest or back pain, often severe in nature.
Duke is an International Registry of Acute Aortic Dissection (IRAD) participating site.
Risk factors for developing an aortic dissection include aortic aneurysm, high blood pressure, current or prior history of smoking, and atherosclerosis. Those with a connective tissue disorder, such as the Marfan syndrome, are also at increased risk of aortic dissection.
Acute aortic dissection is generally classified as either:
Type A dissection represents a surgical emergency, with a mortality rate as high as 1 percent per hour without surgical treatment.
Duke Life Flight allows emergency air transport of these critically ill patients to Duke University Medical Center, where they are taken directly to the operating room for surgical intervention with Duke cardiac surgeons.
Type B dissection patients also frequently require surgical intervention for so-called "complicated" dissection. This generally refers to type B dissection associated with impending or frank rupture or malperfusion of critical vascular beds.
These patients may also gain immediate access to the Duke University Health System via Life Flight.
These complicated lesions are increasingly being treated with endovascular stent techniques, with results superior to open surgery.
Sometimes, an uncomplicated type B dissection can be treated with medical therapy instead of surgery. These patients will need close monitoring with frequent imaging of their dissected aorta by CT scan or MRI.