Symptoms of aortic dissection
The so-called leading symptom, which is described by more than 9 out of 10 patients with an acute dissection, is an acute, very severe pain in the chest or abdominal area or in the back. The pain is described by those affected as very intense and stabbing or tearing, sometimes patients lose consciousness simply because of the intensity of the pain. With type A dissection, the pain is felt more in the chest area, with type B dissection more between the shoulder blades to the abdomen and back.
If a wandering pain occurs, this indicates a spreading dissection. In rare cases, the dissection is completely painless, so that it is conspicuous by chance. Depending on the height at which the dissection is located and which outgoing blood vessels are affected, complications can occur in the most varied organ systems.
If the heart is involved, there may be shortness of breath and shock symptoms. If the brain-supplying arteries are affected, stroke-like symptoms may occur. In case of a reduced blood supply of the intestine or kidneys, severe abdominal or flank pain may occur. In the case of reduced blood flow in the arms and legs, pain in the extremities may occur. An undersupply of the spinal cord with paraplegia is also possible.
Treatment of aortic dissection according to guidelines
A medical guideline provides a recommendation for the therapy and diagnosis of certain clinical pictures. In contrast to the guideline, it is not binding, but must always be individually adapted to the patient. In a classification system, different quality levels are distinguished, whereby an S3 guideline is of higher value than an S1 or S2 guideline.
Currently, there are several recommendations for the management of patients with aortic dissection (e.g. from the German Society of Vascular Surgery or the European Society of Cardiology). There is currently no generally accepted S3 guideline, so the final decision always rests with the treating physician. However, general standards in diagnostics (e.g. imaging procedures such as CT, echocardiography or MRI and angiography) and therapy (surgical vs. interventional vs. drug treatment) are handled similarly in all hospitals in Germany (see treatment/therapy).
Therapy of aortic dissection
In the therapy of aortic dissections it is important to distinguish between acute and chronic, and between type A and type B dissections. An acute type A dissection is always an immediate indication for emergency surgery, since the risk of a fatal rupture increases with time. A chronic type A dissection usually has to be corrected surgically, but the risk of rupture is much lower, so the operation does not have to be performed as an emergency.
The risk of rupture is much lower with type B dissection than with type A dissection, so that conservative (drug therapy) treatment is used if the course of the disease is uncomplicated. Analyses have shown that the 30-day mortality rate with surgical treatment of a type B dissection is around 30%, whereas the 30-day mortality rate with purely drug treatment is only 10%. In the case of complications such as reduced perfusion of various organ systems (see symptoms), endovascular/interventional catheterization, e.g. with stents, can be used. A type B dissection is only operated on in selected cases, including an impending or already occurred rupture, an increasing enlargement of the aortic diameter, in patients with Marfan syndrome or a retrograde extension into the ascending aorta.