Managing even the most challenging tears in the lining of the aorta
Aortic dissection is a serious and sometimes fatal condition, but the experts in our Complex Aortic Center are helping more people live long and healthy lives. Our vascular and cardiac surgeons work together to repair even the most complex tears in the body’s largest blood vessel, including using a minimally invasive approach called endovascular repair.
Some of our patients travel hundreds of miles to receive the specialized surgeries they need for aortic dissections. They may have been told by other doctors that they were too ill for surgery, or they may have multiple tears that created new blood passageways that require advanced skills and technology to repair. We’ll work with you to find the best option to treat your aortic dissection with medication, endovascular repair, or traditional open surgery.
Types of aortic dissection treatment
Medication can play an important role in treating aortic dissections by lowering blood pressure and relieving strain on the damaged aorta. Even if your dissection needs to be repaired, your doctor will likely still prescribe medication.
We start most patients on a beta blocker to lower blood pressure by widening the arteries, blocking adrenaline, and reducing the force of your heart’s contractions. You also may be prescribed:
- ACE inhibitors
- Calcium channel blockers
- Nitroprusside (to relax blood vessels)
Aortic dissection surgery
Surgery is the standard treatment for Type A dissections (ascending aorta), though some patients are too sick to undergo an operation and may rely on medication. Patients with Type B dissections (descending aorta) also may need to be treated if:
A large aneurysm has formed
- Medication cannot manage the condition
- The aorta is at risk of rupturing
- The dissection is interfering with the major arteries branching off the aorta, causing problems in organs or the arms or legs
- There is internal bleeding
For Type A dissections, you will be given general anesthesia and placed on cardiopulmonary bypass, in which a machine temporarily takes over the function of the heart and lungs. This allows the surgical team to slow the heart and clear the aorta of blood, while still providing blood and oxygen to the body. Your body temperature will be lowered so that you consume less oxygen.
The surgeon will make an incision in the aorta to inspect the extent of the tear and determine if other vessels or body parts also require repair. The damaged aorta will be replaced with a long-lasting synthetic graft. Type A dissections also may damage the aortic root. This damage usually can be repaired, but in some cases, the aortic root may need to be replaced. This involves removing the aortic tissue and replacing it with a long-lasting synthetic graft, reattaching the coronary arteries and repairing or replacing the aortic valve.
Finally, your body will be warmed, you’ll be taken off bypass, and the incision will be closed. The procedure takes 5 to 10 hours, and you’ll need to stay in the hospital 7 to 10 days. It can take several months to fully recover.
While surgery remains an important tool for treating Type A dissections (ascending aorta), our team is among those advancing minimally invasive repair for patients with Type B dissections (descending aorta). Endovascular repair offers advantages over open surgery, including less pain, faster recovery, and fewer complications.
Before the procedure, you’ll be given either general anesthesia or a local anesthetic and sedative. The doctor will make two small punctures to access the femoral artery in your groin, through which they will thread two thin, flexible tubes known as catheters through the artery to the dissection and treat the dissection with a stent graft.
The procedure will take two to three hours, and you’ll likely spend a day or two in the hospital.
An aneurysm is a ballooning or expansion of a blood vessel. Aneurysms most often develop in arteries, though they also can develop in veins or even inside the heart.
A dissection is a tear in the lining of the aorta, the candy cane-shaped artery that delivers oxygen-rich blood from the heart to the rest of the body.
Cardiac catheterization is a minimally invasive way to diagnose and treat a variety of heart and vascular conditions by guiding thin, flexible tubes called catheters through blood vessels to problem areas.
The cardiac computed tomography scan, or cardiac CT, uses X-rays to create three-dimensional images of your heart and blood vessels.
Magnetic resonance imaging, better known as cardiac MRI, is a combination of radio waves, magnets, and computer technology to create images of your heart and blood vessels.
Transesophageal echocardiogram allows us to take very detailed images of your heart structure from a probe in your esophagus.
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