In the majority of cases, the thoracic aorta is affected, whereby a rough distinction is made as to whether the tear occurs close to the heart (type A according to Stanford) or only after the left shoulder artery (subclavian artery; type B according to Stanford) has departed. Acute aortic dissection is an emergency that requires immediate treatment. First, emergency doctors administer painkillers and medication to lower blood pressure. The patient is then taken to a hospital for further assessment and treatment.
Procedure
At the hospital, a computer tomography scan is performed as quickly as possible to show the aorta and the location of the tear. In the case of a type A dissection, treatment is carried out by our colleagues in cardiac surgery, in the case of a type B dissection by us in the Clinic for Vascular Surgery.
Acute aortic dissection type B usually does not require surgery, but initially requires intensive medical monitoring, blood pressure control and adequate pain therapy. This takes place over at least 7 days on a monitoring ward. New computer tomography examinations are carried out regularly (every 3-4 days) to show whether anything has changed in the aorta. If the blood pressure and pain respond well to the medication administered, a transfer or hospital discharge can be planned.
In rare, more complicated cases, surgical (usually minimally invasive catheter-based) treatment may be considered for complications of type B aortic dissection. This is necessary if there is a life-threatening rupture of the aortic wall (“aortic rupture”) or a blockage of vascular outlets through the membrane with the threat of reduced organ perfusion.
In most cases, this can be done minimally invasively by implanting a stent prosthesis. In so-called “endovascular stent graft implantation”, a covered vessel support (stent graft) is implanted. This is intended to seal the tear and restore normal blood flow in the “true channel”. The weakened wall section can thus be bridged.
Other open surgical operations are rarely necessary, in which vessels have to be bypassed or blood clots removed.
Aftercare
With or without surgery, it is important that patients undergo regular check-ups with their doctor. For example, he checks the general state of health, the blood pressure setting and changes in the aortic dissection itself. This requires new imaging at least once a year so that possible complications and consequences can be recognized and treated in good time. In 20% of patients, the weakened part of the wall causes vascular dilatations, so-called aneurysms, to form after a few years, which can burst if not treated and lead to severe bleeding. However, if detected in time, this can usually be treated again by minimally invasive stent graft implantation.
More than 100 aortic dissections are treated at the USZ every year. This makes the USZ one of the leading centers in Switzerland and Europe for treatment in this field. There is close interdisciplinary cooperation between cardiac and vascular surgery, as well as well-established cardiovascular anesthesia and intensive care medicine, which has led to outstanding results in the treatment of aortic dissections.