Definition
Aortic dissection is a bleeding into the wall of the aorta of the body. In the process, the vessel wall splits into its various layers and blood flows between these individual layers. This creates a new channel next to the aorta through which blood can also flow.
Aortic dissection of the Stanford A type refers exclusively to such a splitting in the area of the so-called ascending aorta. This is the part of the aorta that is located directly next to the heart. Type B, on the other hand, involves the rest of the aorta.
Diagnosis
Type A aortic dissection is often an emergency. Therefore, if symptoms suggest the suspicion of aortic dissection, the most reliable and fastest diagnostic procedure must be chosen. In most cases, a CT with contrast medium is performed for this purpose, as this is a very fast and accurate imaging procedure.
The exact location of the dissection can also be shown. Other procedures include ultrasound of the chest area, an MRI (duration approx. 30 minutes) or a conventional X-ray.
Symptoms
Typical for an aortic dissection is a so-called pain of destruction. This is the strongest pain that starts suddenly. In type A aortic dissection, the centre of pain is located in the thorax.
In addition, the pain can occur between the shoulder blades and radiate into the back over the entire area of the thoracic spine. It is also possible for the pain to radiate into the abdomen. However, this is more likely to indicate an aortic dissection in the section of the aorta that actually lies in the abdominal cavity.
The pain is often described by affected individuals as burning or tearing. The aortic dissection leads to an altered blood flow. Some organs are no longer supplied with sufficient blood.
Since type A is a dissection in the initial part of the aorta, all organs can be affected. In the brain, for example, a lack of blood quickly causes fainting. If the coronary arteries that leave the ascending aorta are affected, a heart attack occurs with sudden pain and pressure on the chest. Shortness of breath can also occur. An aortic dissection can be accompanied by severe and sudden blood loss, leading to a state of shock that may require resuscitation.
What is the life expectancy with type A aortic dissection?
A type A aortic dissection is usually a difficult emergency situation. If the dissection is accompanied by high blood loss, the chances of survival are very poor. Within a few minutes, the heart pumps the entire blood volume of the body through the aorta.
As a result, a large proportion of the affected individuals do not reach a hospital in time. If quick action was taken in this emergency situation, emergency surgery and the additional administration of blood can be life-saving. Nevertheless, survival within the next 30 days is critical.
About 80% of the operated persons survive this period. Even without acute severe blood loss, type A aortic dissection is often fatal. Of those who decide against surgery, only half survive the next 30 days.
Even despite surgery, about 20% of those treated die. Those who survive the critical interval of 30 days have a fairly good life expectancy. In the following period it plays a decisive role whether risk factors can be contained. High blood pressure must be treated in the same way as hypercholesterolemia (an increase in blood lipid levels), which leads to calcification of the vessels. A healthy diet and regular physical activity also have a positive effect on the cardiovascular system and can thus improve life expectancy.
