Introduction
The aorta is the main artery and runs from the heart to the legs, where it splits. A rupture of the aorta is life-threatening because even a small tear can lead to mass bleeding in seconds. The tear of the aorta is relatively rare, it is indicated in the literature with about 5/100.
000. However, this figure only refers to aortic tears caused by aortic aneurysms. Aneurysms are defects in the vessel wall which can lead to sacculation of the vessel or to holes, so-called perforations, in the vessel wall. Aortic tears caused by accidents are therefore not listed in the literature.
Classification of an aortic tear
The aorta (main artery) is a vessel that is made up of three different layers. These layers consist of elastic fibers, connective tissue and muscle cells. However, these layers can be separated from each other by different triggers.
This separation is described in the specialist literature as dissection. Furthermore, the aorta can be divided into different sections. For example, it can be divided into an upper and lower section.
The upper section is near the heart, while the lower section is far from the heart. Depending on the area in which the dissection is located, it can be divided into different types. A type A aortic dissection is a tear in the vessel wall where the entrance opening of the tear is located in the first section of the aorta (so-called ascending aorta).
Consequently, this tear is located near the heart. Type A dissection represents an acutely life-threatening condition and various consequential damages to the heart can occur within a short time. On the one hand, the rupture of the vessel wall can spread to the coronary arteries and thus lead to a heart attack.
On the other hand, it can lead to a sudden final disruption of the aortic valve (aortic insufficiency), which can also be fatal. Therefore, if an aortic injury is suspected, imaging must be performed as soon as possible. If a type A aortic dissection is diagnosed, emergency surgery must be initiated immediately, in which an attempt is made to replace the affected aortic segment with a vascular prosthesis.
Despite timely measures being taken, the risk of a fatal outcome is high. A type B aortic dissection is present when the aortic tear of the vessel wall lies below the vessel outlet of the left subclavian artery. This means that, unlike type A, this tear is far from the heart.
Emergency surgery is only indicated in rare cases for type B. Initially, an attempt is made to keep the patient’s condition stable by means of medication and close clinical controls. After further diagnostic measures, the torn aortic wall can then be stabilized by a planned open surgery or by a vascular stent which is advanced over a groin artery.
An aortic aneurysm describes a vascular bagging of the aorta. This aneurysm is caused by a dilatation of the vessel wall, since the various layers that make up the vessel wall are weakly developed in this area. Above all, the elastic fibres and muscle cells are displaced, which give the vessel stability.
As a result, the vessel expands over time until it becomes a sacculation, which is associated with a risk of rupture. Risk factors that favour the development of an aneurysm include high blood pressure, nicotine consumption and hereditary factors. There are three different types of aneurysms: The last of which is not actually classified as an aneurysm.
From a critical diameter of the aneurysm onwards, the risk of aortic rupture increases, so that surgery might be recommended. A rupture of the aorta due to an aneurysm can suddenly lead to life-threatening internal bleeding and only immediate surgery has a chance of saving the patient’s life. – Aneurysm verum
- Aneurysm falsum and
- Aneurysm dissecans
