which type of aortic dissection is worse

What is a type A Aortic dissection?

An aortic dissection is caused by a weakened area of the aorta's wall. Aortic dissections are divided into two groups, depending on which part of the aorta is affected: Type A. This more common and dangerous type involves a tear in the part of the aorta where it exits the heart.

What are the dangers of an aortic dissection?

The danger is that the dissection channels blood out of your aorta. This could cause fatal complications, such as rupture of the dissected artery or severe blockage of blood flow where it should be occurring through the normal lumen of the aorta.

Is aortic dissection more common in males or females?

Aortic dissection is more common in blacks than in whites and is less common in Asians than in whites. Also, it is more common in males than females, with a male-to-female ratio of 2-3:1. Approximately 75% of dissections occur in those aged 40-70 years, with a peak in the range of 50-65 years 6).

What is the difference between Type A and Type B dissection?

In the Stanford classification of aortic dissection: Type A involves the ascending aorta and may progress to involve the arch and thoracoabdominal aorta. Type B involves the descending thoracic or thoracoabdominal aorta distal to the left subclavian artery without involvement of ascending aorta.

Is Type A or Type B aortic dissection more common?

There are two types of aortic dissections: Type A which is the more common and dangerous of the two and involves a tear in the part of the aorta where it exits the heart or a tear in the upper, or ascending aorta, which may extend into the abdomen.

Which type of aortic dissection is associated with the highest rate of mortality?

An acute aortic dissection is associated with very high mortality; the majority die even before reaching the emergency department. Patients with a chronic aortic dissection (more than two weeks) have a slightly better prognosis.

Which type of aortic dissection is more common?

Aortic dissections are divided into two groups, depending on which part of the aorta is affected: Type A. This more common and dangerous type involves a tear in the part of the aorta where it exits the heart. The tear may also occur in the upper aorta (ascending aorta), which may extend into the abdomen.

How long can you live with an aortic dissection type B?

Despite adequate antihypertensive therapy, the long-term prognosis of these patients is characterized by a significant aortic aneurysm formation in 25-30% within four years, and survival rates from 50 to 80% at five years and 30 to 60% at 10 years.

How serious is a type B aortic dissection?

The most serious complication is rupture of the aorta, which causes internal bleeding and often leads to death. In addition, the build-up of blood in the wall of the aorta can disrupt normal blood flow down the thorax and abdomen. This can compromise blood supply to organs such as the kidney and intestines.

What are the odds of surviving an aortic dissection?

Prognosis for Aortic Dissection Hospital mortality rate for treated patients is about 30% for proximal dissection and 10% for distal. For treated patients who survive the acute episode, survival rate is about 60% at 5 years and 40% at 10 years.

What is life expectancy after aortic dissection surgery?

Although specific information about overall life expectancy after aortic dissection repair is not available, a recent study from the International Registry of Acute Aortic Dissection reported that about 85% of patients who have undergone successful repair of acute dissection involving the ascending aorta remain alive ...

Can you live a normal life after aortic dissection?

With excellent blood pressure control and conscious limits to physical activity, you can continue to live a long, full life after a dissection. This would include returning to most jobs.

What is type A aortic dissection repair?

A Type A aortic dissection is a medical emergency and requires surgery to repair the tear before further damage occurs. The most typical surgery for aortic dissection is valve sparing root replacement, or the David procedure.

Where is the most common location for aortic dissection?

The most common site of dissection is the first few centimeters of the ascending aorta, with 90% occurring within 10 cm of the aortic valve. The second most common site is just distal to the left subclavian artery. Between 5% and 10% of dissections do not have an obvious intimal tear.

Can you survive an aortic tear without surgery?

In untreated patients, the mortality rate is about 70%, with death most commonly due to intrapericardial aortic rupture.

Can a Type B aortic dissection heal?

It has been generally recommended that patients who have type B aortic dissection without complications are treated with medical therapy in an intensive care unit. Usually, with aggressive antihypertensive therapy, up to 85% of patients may survive their initial hospital stay.

What is type B aortic?

TYPE B AORTIC DISSECTION. Aortic dissection is defined as a tear in the innermost layer of the aortic wall (intima) that results in high pressure flow of blood between the layers of the aorta, creating a true and false lumen.

How do you fix a type B aortic dissection?

Results. All type B dissections require prompt medical treatment to prevent aortic rupture. Acute complicated dissections are nowadays treated by endografting to reroute blood flow into the true lumen and promote false lumen thrombosis and future aortic remodeling.

What percentage of people survive an aortic dissection?

Acute aortic dissection is highly lethal if not recognized and treated aggressively. Approximately 20% of patients with acute aortic dissection die before reaching the hospital. Mortality for an untreated dissection is about 25% at 6 hours and 50% by 24 hours. Within 1 week, two thirds of patients die if untreated.

What is the most dangerous type of aortic dissection?

Aortic dissections are divided into two groups, depending on which part of the aorta is affected: Type A. This more common and dangerous type involves a tear in the part of the aorta where it exits the heart or a tear in the upper aorta (ascending aorta), which may extend into the abdomen. Type B.

When is aortic dissection most common?

The condition most frequently occurs in men in their 60s and 70s. Symptoms of aortic dissection may mimic those of other diseases, often leading to delays in diagnosis. However, when an aortic dissection is detected early and treated promptly, the chance of survival greatly improves.

What is an aortic aneurysm?

Overview. An aortic aneurysm occurs when a weak spot in the wall of your aorta begins to bulge (left). This can occur anywhere in your aorta. Having an aneurysm increases the risk of rupture or an aortic dissection — a tear in the lining of the aorta, shown in the image on the right.

What is a dissection of the aorta?

An aortic dissection is a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). If the blood-filled channel ruptures through ...

What are the symptoms of aortic dissection?

Typical signs and symptoms include: Sudden severe chest or upper back pain, often described as a tearing, ripping or shearing sensation, that radiates to the neck or down the back. Sudden difficulty speaking, loss of vision, ...

How to reduce risk of aortic dissection?

You can reduce your risk of an aortic dissection by preventing chest injury and taking steps to keep your heart healthy.

What is the term for a narrowing of the aorta at birth?

Hardening of the arteries (atherosclerosis) Weakened and bulging artery (pre-existing aortic aneurysm) An aortic valve defect (bicuspid aortic valve) A narrowing of the aorta at birth (aortic coarctation) Certain genetic diseases increase the risk of having an aortic dissection, including: Turner's syndrome.

What are the risk factors for aortic dissection?

Risk factors for aortic dissection include: High blood pressure. The presence of an aneurysm. Atherosclerosis (or buildup of plaque in the arteries) Certain genetic conditions like a bicuspid aortic valve. Connective tissue diseases (such as Marfan syndrome) which run in families.

Why does aortic dissection happen?

Aortic dissection happens because there is an underlying, slow breakdown of the cells that make up the walls of your aorta. The breakdown has likely been going on silently for many years before the weakened area of the aortic wall finally gives way, resulting in a tear, which leads to the aortic dissection.

What is Stanford type A aortic dissection?

Stanford Type A Aortic Dissection: This type of dissection occurs in the first part of the aorta, closer to the heart, and can be immediately life-threatening. It usually requires emergency open chest surgery to repair or replace the first segment of the aorta where the tear started (ascending aorta +/- the arch and/or aortic valve). This is a more common type of dissection than Type B, and the dissection of the aorta usually extends through the entire length of the aorta.

What is an aortic rupture?

An aortic rupture is a complete tear through all three layers of the aorta — like a rip or a hole — in the wall of the aorta. Blood bursts through the hole into the surrounding body cavity.

Why does the aorta wall weaken in some people and not others?

In others, the stress to the aortic wall from constant high blood pressure can weaken the aorta wall in susceptible people, resulting in a tear and dissection.

Why does the aorta bulge?

Over time, the stress of blood flow between aortic layers can cause the weakened area of the aorta to bulge like a balloon, stretching the aorta into what is called an aneurysm – with the risk for late rupture and associated death. Many patients may require future surgeries to repair late developing aneurysms.

How do you know if your aorta is tearing apart?

When dissection first occurs and the layers of the aorta are forced apart, it usually feels like a severe, sharp, tearing pain in your chest and back. It feels like your aorta is ripping apart. Other symptoms include. Shortness of breath. Fainting or dizziness.

Which type of dissection involves the ascending aorta?

Type A aortic dissection – The ascending aorta is involved (DeBakey types I and II)

How long does it take to die from aortic dissection?

An acute aortic dissection (<2 weeks) is associated with high morbidity and mortality rates. Mortality is highest in the first 7 days; indeed, many patients die before presentation to the emergency department or before diagnosis is made in the emergency department.

What are the two major anatomic classification schemes for aortic dissection?

Two major anatomic classification schemes for aortic dissection are the DeBakey and the Stanford systems (see Figure 4 below) 8).

What is a tear in the aortic wall?

Aortic dissection is a serious condition in which there is a tear in the layers within the aortic wall of the major artery carrying blood out of the heart (aorta) (see Figures 1, 2 and 3 below). As the tear extends along the wall of the aorta, blood can flow in between the layers of the blood vessel wall (dissection).

What is the role of the aortic media?

The aortic media contains very little smooth muscle and collagen between the elastic layers and thus has increased distensibility , elasticity, and tensile strength . This contrasts with peripheral arteries, which, in comparison, have more smooth muscle and collagen between the elastic layers.

How to repair a dissected aorta?

Surgeons remove as much of the dissected aorta as possible, block the entry of blood into the aortic wall and reconstruct the aorta with a synthetic tube called a graft. If the aortic valve leaks as a result of the damaged aorta, it may be replaced at the same time. The new valve is placed within the graft used to reconstruct the aorta.

Where is the most common site of dissection?

Distal to the left subclavian artery. The aortic arch. The most common site of dissection is the first few centimeters of the ascending aorta, with 90% occurring within 10 cm of the aortic valve. The second most common site is just distal to the left subclavian artery.

Which type of dissection starts in the descending aorta?

Dissections that start in the descending aorta are classified as type B. They tend to be less life-threatening than type A.

What causes a dissection of the aortic wall?

Anything that weakens your aortic wall can cause a dissection. This includes inherited conditions in which your body tissues develop abnormally, such as Marfan’s syndrome, atherosclerosis, and accidental injuries to the chest.

What is the aorta that travels upward?

The aorta travels upward when it first leaves your heart. This is called the ascending aorta. It then arches downward, passing from your chest into your abdomen. This is known as the descending aorta . A dissection can occur in the ascending or descending part of your aorta. Aortic dissections are classified as type A or type B:

What causes a heart attack?

The following factors can also increase your risk: 1 high blood pressure 2 smoking tobacco 3 atherosclerosis, which is the process of injury, calcified fatty/cholesterol plaque accumulation, and hardening of your arteries 4 conditions such as Marfan’s syndrome, in which your body’s tissues are weaker than normal 5 prior surgery on the heart 6 motor vehicle accidents involving chest injuries 7 a congenitally narrowed aorta 8 a faulty aortic valve 9 cocaine use, which can cause severe abnormalities in your cardiovascular system 10 pregnancy

Why is my aorta dissected?

Causes of dissection of the aorta. Although the exact cause of aortic dissections is unknown, doctors believe that high blood pressure is a contributing factor because it causes strain on the walls of your arteries. Anything that weakens your aortic wall can cause a dissection.

What does it mean when you dissect your aorta?

If you have a dissection of the aorta, it means that blood is leaking outside of the arterial lumen, or interior of the blood vessel. The leaking blood causes a split between the inner and middle layers of the wall of the aorta as it progresses. This can happen if the inner layer of your aorta tears. Sometimes blood hemorrhages from ...

What to do if you have aortic dissection?

Call 911 immediately if you have severe chest pain or other symptoms of an aortic dissection.

What causes aortic dissection?

Other important risk factors include the presence of fatty plaques, areas of weakened tissue and bulging in the aorta and defects of the aortic valve, such as a bicuspid valve. There are also a number of genetic conditions which predispose the aorta to dissection. These include connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome, where the structural support within the aortic wall is weakened.

Can aortic dissection cause shortness of breath?

Individuals with an acute type A aortic dissection typically experience a sudden onset of severe chest pain, which may have a tearing quality and may spread to the neck, jaw or back. Individuals may also experience shortness of breath, loss of consciousness and symptoms similar to those from a stroke, such as sudden difficulty speaking, visual loss and weakness on one side of the body. It should be appreciated that aortic dissection may occasionally occur without any symptoms.

Is aortic dissection fatal?

Aortic dissection is a life-threatening condition which may be rapidly fatal if not detected and treated promptly. The aorta is the main artery which branches off the heart and supplies oxygen-rich blood to the body’s organs and tissues. The wall of the aorta consists of inner, middle and outer layers. Aortic dissection occurs when there is a tear in the inner layer, which allows blood to enter through the tear and fill up between the inner and middle layers, causing these layers to separate or ‘dissect’. Type A dissection occurs when the tear develops in the ascending part of the aorta just as it branches off the heart, while Type B dissection involves the lower aorta. While Type A dissection is the more dangerous form, chances of survival are significantly improved with early detection and management.

What is a dissection of the aortic wall?

An aortic dissection is a life-threatening condition that develops when there is a split in one or more layers of the aortic artery wall, which can be caused by a ruptured aneurysm. The split or tear enables blood to seep between the aortic wall’s three layers, which can eventually lead to aortic rupture and catastrophic bleeding.

What is the cause of an aortic aneurysm?

An aortic aneurysm is a balloon-like bulge, caused by weakness or degeneration in the wall of the aorta, the body’s primary and largest artery that runs from the heart, through the chest and into the abdomen.

What is the treatment for an abdominal aortic aneurysm?

Treatment options include: Medications to lower blood pressure and control cholesterol may be prescribed to manage an abdominal aortic aneurysm or Type B aortic dissection.

What happens if you have a TAA rupture?

Trouble breathing or swallowing. If a TAA ruptures or dissects, sudden, severe, sharp or stabbing pain that starts in the upper back and moves into the abdomen may be felt. Pain may also be felt in the chest and arms. An aortic dissection is a life-threatening condition that develops when there is a split in one or more layers ...

What is an open surgical aneurysm repair?

Open surgical aneurysm repair: an aortic graft is sewn into place to replace the section of artery weakened by the aneurysm, preventing it from rupturing.

What happens if you have a ruptured AAA?

Internal bleeding from a ruptured AAA or TAA is a life-threatening condition in which blood pressure drops so low that the brain, kidneys and other vital organs can't get enough blood to work well. If you have any symptoms of ruptured AAA or TAA, or aortic dissection, call 911.

Where do aortic aneurysms occur?

Most aortic aneurysms occur in the abdominal part of the aorta. AAAs usually develop slowly and often don't cause symptoms until they have grown large enough to press on nearby body parts and block blood flow. At that point, symptoms may include: A throbbing feeling in the abdomen. Deep pain in the back or the side.

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