Materiały źródłowe

• #1 Aortic dissection – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-dissection/diagnosis-treatment/drc-20369499

  An aortic dissection is a medical emergency requiring immediate treatment. Treatment may include surgery or medications, depending on the area of the aorta involved. […] Treatment for type A aortic dissection may include: […] Surgery. Surgeons remove as much of the dissected aorta as possible and stop blood from leaking into the aortic wall. A synthetic tube (graft) is used to reconstruct the aorta. 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. […] Medications. Medications are given to reduce heart rate and lower blood pressure, which can prevent the aortic dissection from worsening. They may be given to people with type A aortic dissection to control blood pressure before surgery. […] Treatment of type B aortic dissection may include:

• #2 Aortic dissection – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-dissection/symptoms-causes/syc-20369496

  Aortic dissection is relatively uncommon. It usually occurs in men in their 60s and 70s. […] However, when an aortic dissection is detected early and treated promptly, the chance of survival greatly improves. […] If you have severe chest pain, fainting, sudden shortness of breath or symptoms of a stroke, call 911 or your local emergency number. Early detection and treatment may help save your life. […] If you have a family history of aortic dissection, a connective tissue disorder or a bicuspid aortic valve, tell your doctor. If you have an aortic aneurysm, find out how often you need monitoring and if surgery is necessary to repair your aneurysm. […] If you have a genetic condition that increases your risk of aortic dissection, your doctor may recommend medications, even if your blood pressure is normal.

• #3 Management of acute aortic dissection in critical care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10572474/

  Aortic dissections are associated with significant mortality and morbidity, with rapid treatment paramount. […] Treatment focuses on initial resuscitation, transfer (if possible and required) to a suitable specialist centre, strict blood pressure and heart rate control and potentially surgical intervention depending on the type and complexity of the dissection. […] The type of dissection and haemodynamic condition of the patient will have significant impact on the management strategy required, both on the intensive care unit and in the operating theatre. […] When managing an acute aortic dissection, initial treatment should concentrate on resuscitation and stabilisation of the patient whilst deciding and preparing for definitive intervention. […] Tight blood pressure control and reduction of the rate of pressure rise during systole is vital to reduce the chances of the dissection propagating further.

• #4 Management of acute aortic dissection in critical care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10572474/

  Aortic dissections are associated with significant mortality and morbidity, with rapid treatment paramount. […] Treatment focuses on initial resuscitation, transfer (if possible and required) to a suitable specialist centre, strict blood pressure and heart rate control and potentially surgical intervention depending on the type and complexity of the dissection. […] The type of dissection and haemodynamic condition of the patient will have significant impact on the management strategy required, both on the intensive care unit and in the operating theatre. […] When managing an acute aortic dissection, initial treatment should concentrate on resuscitation and stabilisation of the patient whilst deciding and preparing for definitive intervention. […] Tight blood pressure control and reduction of the rate of pressure rise during systole is vital to reduce the chances of the dissection propagating further.

• #5 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  Treatment of Aortic Dissection […] Beta-blockers and other medications to control blood pressure […] Usually endovascular repair or open surgical repair […] Patients who do not immediately die of aortic dissection should be admitted to an intensive care unit with intra-arterial blood pressure monitoring and an indwelling urethral catheter to monitor urine output. Blood should be typed and cross-matched for 4 to 6 units of packed red blood cells when surgery is likely. Patients who are hemodynamically unstable should be intubated. […] Medical management […] Medications to decrease arterial pressure, arterial shear stress, ventricular contractility, and pain are started immediately to maintain systolic blood pressure at 120 mm Hg (or the lowest level compatible with adequate cerebral, coronary, and renal perfusion) and to maintain a target heart rate of 60 to 80 beats per minute.

• #6 Management of acute aortic dissection in critical care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10572474/

  In the absence of aortic regurgitation, the first line antihypertensive agent is a beta-blocker, targeting a heart rate of 60-80 beats/min and a systolic blood pressure of 100-120 mmHg. […] Surgery is the standard treatment for acute type A aortic dissection. […] The basic principles are to resect the primary tear, establish blood flow in the true lumen and replace the dissected intrapericardial aorta. […] The first line of treatment of type B dissection is medical management, control of blood pressure and analgesia. […] Approximately 90% of type B dissections can be managed in this way in the acute phase.

• #7 Management of acute aortic dissection and thoracic aortic rupture | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0287-7

  Regardless of whether acute aortic dissection is type A or B, medical therapy to control pain and hypertension is essential in all patients. Beta blockers have the desired effect of reducing blood pressure and heart rate to the normal range. These medications also protect the myocardium against ischemia. For most patients, systolic blood pressure should be controlled between 100 and 120 mmHg with a heart rate of approximately 60 bpm. Otherwise, vasodilators such as calcium channel blockers (nicardipine or diltiazem) or nitroglycerin are useful in reducing hypertension in an emergent situation. […] In patients with type A aortic dissection, surgical treatment is the gold standard; mortality is 50% within the first 48 h if surgery is not performed. However, early mortality after operation remains high at 9-25%. Although surgical results are still unsatisfactory, long-term outcomes after operation are obviously better compared with medical therapy. The aim of surgery in patients with type A aortic dissection is to prevent aortic rupture and pericardial tamponade and to relieve aortic regurgitation. Another goal is to improve blood flow in the branches disturbed by the false lumen.

• #8 Care for the patient with aortic dissection | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/cardiovascular-intensive-care/Chapter-854/care-patient-aortic-dissection

  Care for the patient with aortic dissection […] Medical management of aortic dissection: […] Overall management goals: […] Decrease aortic wall stress […] Thus: […] reduce the risk of rupture […] Decrease the risk of propagation of the dissection flap […] Maintain the perfusion of compromised organs […] Haemodynamic objectives which serve these goals: […] Decrease cardiac contractility (dP/dT) […] Decrease blood pressure […] Decrease heart rate […] All of this reduces the kinetic energy of the ejected blood, which is what dissects the flap […] Options to achieve these goals: […] Labetalol infusion (15mg bolus, then 5mg/hr) […] Infusion initially because easy to transition to oral dosing later […] A good agent choice because it also has alpha blocking properties

• #9 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  A beta-blocker is usually the first-line medication for heart rate and blood pressure control. Options include […] Metoprolol tartrate IV […] Esmolol IV […] Labetalol (an alpha- and beta-adrenergic blocker) IV […] Alternatively, nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) can be used to control blood pressure and heart rate in patients who do not tolerate beta-blockers. […] If systolic blood pressure remains 110 mm Hg despite use of beta-blockers or nondihydropyridine calcium channel blockers, nitroprusside can be given in a constant IV infusion, titrated as necessary to control blood pressure. Nitroprusside should not be given without a beta-blocker or nondihydropyridine calcium channel blocker because reflex sympathetic activation in response to vasodilation can increase ventricular inotropy and aortic shear stress, worsening the dissection.

• #10 Medication for Aortic Dissection | NYU Langone Health

  https://nyulangone.org/conditions/aortic-dissection/treatments/medication-for-aortic-dissection

  Unlike type A aortic dissections that require surgery, type B aortic dissections are often treated with medications that lower blood pressure. […] Type B dissections typically respond well to medical treatment that decreases the stress of blood pressure on the aortic wall. This reduces pain from the aortic dissection and helps prevent the tear from worsening. […] Beta blockers are often the first treatment for a type B aortic dissection. These medications reduce blood pressure by blocking the effects of the hormone epinephrine, or adrenaline. This relaxes the heart, slowing it down. Less blood leaves the heart, and it leaves with less force. […] If controlling blood pressure doesn’t reduce the pain from a dissection, doctors may prescribe pain medication, such as acetaminophen or a nonsteroidal anti-inflammatory drug.

• #11 Aortic Dissection

  https://aci.health.nsw.gov.au/networks/eci/clinical/tools/cardiology/aortic-dissection

  Immediate cardiothoracic referral on strong suspicion. […] Large bore IV access. […] Cross match 6 units of packed cells and consider alerting blood bank (to activate massive transfusion protocol). […] Fluid resuscitation with blood products if required (no more than MAP 65). […] Fentanyl PCA to control pain (decreases sympathetic output). […] Target HR 60-80. Esmolol may be given as an initial bolus of 40 mg IV infusion 20mg/min OR Labetalol to 20 mg IV with repeat doses of 20-40 mg every 10 minutes to effect or a total dose of 300 mg OR Metoprolol may be given in 5mg repeated 5 minutely to a 15mg initial bolus infusion 5mg/hr. […] Target right arm BP 100-120 systolic: Right arm likely most accurate, or use higher number. […] Place art line. […] BP control after Beta blocking: Sodium Nitroprusside 0.3 microgram/kg/min IV titrated to effect. […] Correct coagulopathy. […] Stanford Type A – Surgical repair represents the mainstay of treatment. […] Stanford Type B – Medical management is the gold standard although endovascular surgery sealing of the intimal entry tear offers potential management in the complicated tears.

• #12 Treatment of Aortic Dissection in the Emergency Department

  https://emcrit.org/emcrit/aortic-dissection/

  Aortic Dissection Treatment, therapy […] Control Pain with fentanyl […] Control Heart Rate/Inotropy with esmolol […] Control Blood Pressure […] With in order of preference: clevidipine, nicardipine, nitroprusside, nitroglycerin […] If the patient has contra-indications to beta-blockers, substitute diltiazem for esmolol. […] Nicardipine and Esmolol are compatible and can be given through the same IV. […] Options include adding clevidipine, nitroprusside, or hydralazine.

• #13 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  A beta-blocker is usually the first-line medication for heart rate and blood pressure control. Options include […] Metoprolol tartrate IV […] Esmolol IV […] Labetalol (an alpha- and beta-adrenergic blocker) IV […] Alternatively, nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) can be used to control blood pressure and heart rate in patients who do not tolerate beta-blockers. […] If systolic blood pressure remains 110 mm Hg despite use of beta-blockers or nondihydropyridine calcium channel blockers, nitroprusside can be given in a constant IV infusion, titrated as necessary to control blood pressure. Nitroprusside should not be given without a beta-blocker or nondihydropyridine calcium channel blocker because reflex sympathetic activation in response to vasodilation can increase ventricular inotropy and aortic shear stress, worsening the dissection.

• #14 Aortic Dissection Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/aortic-dissection/treatment-options

  Aortic dissection is typically treated using either medication or through surgery. Your doctor will work with you to determine which approach will yield the best results for you. […] In acute Type B dissection, intravenous medications are prescribed to reduce blood pressure quickly (eg, vasodilators such as nitroprusside, hydralazine, beta blockers) and to manage pain (eg, morphine). Longer term medications include beta blocker therapy. […] Dissections of the ascending aorta (Type A) and other high-risk dissections of the descending aorta (Type B) (eg, with blocked blood flow to organs, pain, expansion of dissection, uncontrolled hypertension) often require emergency surgery and related operative procedures. Surgical therapies include: Artificial aortic graft is the surgical removal of the torn section of the aorta and replacement with a segment of artificial vessel wall. Reinforcement of dissected aorta which is often performed using minimally invasive (endovascular) procedures to guide and place a mesh tube (stent) inside the torn vessel for reinforcement. Complex multi-step repairs of aortic arch aneurysms. Special operations for patients with connective tissue disease. Valve-sparing aortic root replacement operations. Minimally invasive treatment of heart conditions that either aggravate the dissection or limit the success of the planned surgical repair.

• #15 Treatment of Aortic Dissection in the Emergency Department

  https://emcrit.org/emcrit/aortic-dissection/

  Aortic Dissection Treatment, therapy […] Control Pain with fentanyl […] Control Heart Rate/Inotropy with esmolol […] Control Blood Pressure […] With in order of preference: clevidipine, nicardipine, nitroprusside, nitroglycerin […] If the patient has contra-indications to beta-blockers, substitute diltiazem for esmolol. […] Nicardipine and Esmolol are compatible and can be given through the same IV. […] Options include adding clevidipine, nitroprusside, or hydralazine.

• #16 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  A beta-blocker is usually the first-line medication for heart rate and blood pressure control. Options include […] Metoprolol tartrate IV […] Esmolol IV […] Labetalol (an alpha- and beta-adrenergic blocker) IV […] Alternatively, nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) can be used to control blood pressure and heart rate in patients who do not tolerate beta-blockers. […] If systolic blood pressure remains 110 mm Hg despite use of beta-blockers or nondihydropyridine calcium channel blockers, nitroprusside can be given in a constant IV infusion, titrated as necessary to control blood pressure. Nitroprusside should not be given without a beta-blocker or nondihydropyridine calcium channel blocker because reflex sympathetic activation in response to vasodilation can increase ventricular inotropy and aortic shear stress, worsening the dissection.

• #17 Aortic Dissection Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Overview

  https://emedicine.medscape.com/article/2062452-treatment

  Medical management consists of decreasing the blood pressure and the shearing forces of myocardial contractility in order to decrease the intimal tear and propagation of the dissection. Medical management with antihypertensive therapy, including beta blockers, is the treatment of choice for all stable chronic aortic dissections. […] Pain management is an important but difficult aspect of medical therapy. Narcotics and opiates are the preferred agents. […] The major objectives of surgery for aortic dissection are to alleviate the symptoms, decrease the frequency of complications, and prevent aortic rupture and death. The affected layers of the aorta are sutured together, and the aorta is reinforced with a Dacron graft. […] Endovascular therapy is rapidly emerging as the preferred treatment for descending aortic dissection, provided vascular access is available. This methodology still remains controversial for ascending dissection.

• #18 Medication for Aortic Dissection | NYU Langone Health

  https://nyulangone.org/conditions/aortic-dissection/treatments/medication-for-aortic-dissection

  Unlike type A aortic dissections that require surgery, type B aortic dissections are often treated with medications that lower blood pressure. […] Type B dissections typically respond well to medical treatment that decreases the stress of blood pressure on the aortic wall. This reduces pain from the aortic dissection and helps prevent the tear from worsening. […] Beta blockers are often the first treatment for a type B aortic dissection. These medications reduce blood pressure by blocking the effects of the hormone epinephrine, or adrenaline. This relaxes the heart, slowing it down. Less blood leaves the heart, and it leaves with less force. […] If controlling blood pressure doesn’t reduce the pain from a dissection, doctors may prescribe pain medication, such as acetaminophen or a nonsteroidal anti-inflammatory drug.

• #19 Aortic Dissection

  https://aci.health.nsw.gov.au/networks/eci/clinical/tools/cardiology/aortic-dissection

  Immediate cardiothoracic referral on strong suspicion. […] Large bore IV access. […] Cross match 6 units of packed cells and consider alerting blood bank (to activate massive transfusion protocol). […] Fluid resuscitation with blood products if required (no more than MAP 65). […] Fentanyl PCA to control pain (decreases sympathetic output). […] Target HR 60-80. Esmolol may be given as an initial bolus of 40 mg IV infusion 20mg/min OR Labetalol to 20 mg IV with repeat doses of 20-40 mg every 10 minutes to effect or a total dose of 300 mg OR Metoprolol may be given in 5mg repeated 5 minutely to a 15mg initial bolus infusion 5mg/hr. […] Target right arm BP 100-120 systolic: Right arm likely most accurate, or use higher number. […] Place art line. […] BP control after Beta blocking: Sodium Nitroprusside 0.3 microgram/kg/min IV titrated to effect. […] Correct coagulopathy. […] Stanford Type A – Surgical repair represents the mainstay of treatment. […] Stanford Type B – Medical management is the gold standard although endovascular surgery sealing of the intimal entry tear offers potential management in the complicated tears.

• #20 Management of acute aortic dissection and thoracic aortic rupture | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0287-7

  Regardless of whether acute aortic dissection is type A or B, medical therapy to control pain and hypertension is essential in all patients. Beta blockers have the desired effect of reducing blood pressure and heart rate to the normal range. These medications also protect the myocardium against ischemia. For most patients, systolic blood pressure should be controlled between 100 and 120 mmHg with a heart rate of approximately 60 bpm. Otherwise, vasodilators such as calcium channel blockers (nicardipine or diltiazem) or nitroglycerin are useful in reducing hypertension in an emergent situation. […] In patients with type A aortic dissection, surgical treatment is the gold standard; mortality is 50% within the first 48 h if surgery is not performed. However, early mortality after operation remains high at 9-25%. Although surgical results are still unsatisfactory, long-term outcomes after operation are obviously better compared with medical therapy. The aim of surgery in patients with type A aortic dissection is to prevent aortic rupture and pericardial tamponade and to relieve aortic regurgitation. Another goal is to improve blood flow in the branches disturbed by the false lumen.

• #21 Aortic Dissection: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16743-aortic-dissection

  Aortic dissection treatment depends on the location of the tear and dissection. […] For Type A aortic dissection (when it involves the first part of the aorta close to your heart), you need immediate surgery. […] For Type B aortic dissection, you need emergency surgery if the dissection cuts off blood flow to your vital organs and body parts. […] Surgical options include: Graft replacement: A surgeon removes a portion of the damaged section of your aorta and sews a synthetic fabric tube (graft) directly in its place. […] Endovascular stent-graft repair: A provider repairs your aorta from within by using a stent graft a synthetic fabric tube with metal wire stents for support (like a scaffold). […] A provider may prescribe medications like beta-blockers to lower your heart rate and blood pressure.

• #22 Aortic Dissection Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Overview

  https://emedicine.medscape.com/article/2062452-treatment

  Acute aortic dissection can be treated surgically or medically. In surgical treatment, the area of the aorta with the intimal tear is usually resected and replaced with a Dacron graft. […] Emergency surgical correction is the preferred treatment for Stanford type A (DeBakey type I and II) ascending aortic dissection. It is also preferred for complicated Stanford type B (DeBakey type III) aortic dissections with clinical or radiologic evidence of the following conditions: […] Medical management remains the treatment of choice for descending aortic dissections unless they are leaking or ruptured. With the progress in stenting technology, descending dissections can be approached with this modality in selected cases. […] Medical therapy is also administered to surgical patients preoperatively, intraoperatively, and postoperatively to prevent progression or recurrence of aortic dissection.

• #23 Aortic dissection – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-dissection/diagnosis-treatment/drc-20369499

  An aortic dissection is a medical emergency requiring immediate treatment. Treatment may include surgery or medications, depending on the area of the aorta involved. […] Treatment for type A aortic dissection may include: […] Surgery. Surgeons remove as much of the dissected aorta as possible and stop blood from leaking into the aortic wall. A synthetic tube (graft) is used to reconstruct the aorta. 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. […] Medications. Medications are given to reduce heart rate and lower blood pressure, which can prevent the aortic dissection from worsening. They may be given to people with type A aortic dissection to control blood pressure before surgery. […] Treatment of type B aortic dissection may include:

• #24 Aortic Dissection: Causes, Symptoms & Treatment | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/conditions/aortic-dissection-type-a-and-type-b

  Aortic dissection is a life-threatening condition and needs to be treated right away. Surgery is necessary for most Type A dissections, but medications such as beta blockers and nitroprusside may be prescribed to reduce the heart rate and lower blood pressure to prevent aortic dissection from worsening in an effort to stabilize blood pressure prior to surgery. […] Type B dissections may be treated with surgery or with the same medications used for those with type A without surgery. There are two surgical techniques used: Open chest or abdominal surgery requiring an incision made in the chest or abdomen. […] Endovascular surgery to repair the aorta which is performed without major surgical incisions using thoracic stent-grafts inserted through the femoral artery in the groin. […] For patients with type A dissection, 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 (graft).

• #25 Aortic dissection – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_dissection

  Indications for the surgical treatment of aortic dissection include an acute proximal aortic dissection and an acute distal aortic dissection with one or more complications. […] The objective in the surgical management of aortic dissection is to resect (remove) the most severely damaged segments of the aorta and to obliterate the entry of blood into the false lumen (both at the initial intimal tear and any secondary tears along the vessel). […] Open aortic surgery with replacement of the damaged section of the aorta with a tube graft (often made of Dacron) when no damage to the aortic valve is seen. […] Thoracic endovascular aortic repair, a minimally invasive surgical procedure usually combined with ongoing medical management.

• #26 Aortic Dissection | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/aortic-dissection.html

  Because aortic dissection is a life-threatening condition, treatment is typically needed immediately. Treatment usually involves surgery; however, in some cases, if the tear occurs in the area of the aorta that is descending into the abdomen, medication may be used to treat the condition. Medication may also be used to stabilize a patient’s condition before surgery. […] Surgery will focus on removing the damaged portion of the aorta and placing a graft in place of the removed portion in order to prevent blood from running into the aortic layers. The graft is generally a tube made of synthetic material that helps restore function to the damaged area. In some cases, the aortic dissection may have damaged the aortic valve. If this occurs, the valve will often be replaced during the same surgery.

• #27 Impact of time between diagnosis to treatment in Acute Type A Aortic Dissection | Scientific Reports

  https://www.nature.com/articles/s41598-021-83180-6

  There is a paucity of data describing the effect of time interval between diagnosis and surgery for Acute Type A Aortic Dissection. […] Time intervals between symptom onset, diagnosis and surgery have a significant effect on mortality. Surgery performed 812 h after diagnosis carries the highest mortality, which may be exacerbated by longer interval since symptom onset. […] Acute Type A Aortic Dissection (ATAAD) remains a highly morbid diagnosis with relatively high mortality and few definitive treatment options aside from surgery. Mortality increases in a time-dependent manner, with published data demonstrating mortality increases of 12% per hour in the first 24 h; thus, early diagnosis and treatment are paramount in achieving successful outcomes. Emergency surgery is the preferred management strategy once the diagnosis of ATAAD is confirmed. […] Our results demonstrate that surgical intervention within 4 h of diagnosis leads to significantly better outcomes; ATAAD must continue to be considered a time-sensitive emergency and steps taken to expedite surgery.

• #28 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  The type and location of the dissection classified by the Stanford or DeBakey systems determine the need for surgical or medical intervention. […] Type A dissections are considered surgical emergencies due to the risk of catastrophic complications such as cardiac tamponade, severe aortic regurgitation, myocardial infarction, or aortic rupture. Surgical mortality varies from 5% to 20%. Surgical intervention involves: Excision of the intimal tear, Aortic replacement, Aortic valve assessment and repair/replacement. […] Uncomplicated type B dissections are typically managed with aggressive blood pressure and heart rate control. The goal is to reduce aortic wall stress, prevent progression, and monitor for complications. […] Endovascular stent-grafting is preferred for complicated type B dissections. TEVAR involves placing a stent-graft to seal the dissection entry tear and exclude the false lumen, promoting healing and remodeling of the aorta. TEVAR is associated with significantly lower morbidity and mortality compared to open surgical repair.

• #29 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  The extent of repair depends upon the reason for repair and the anatomic nature of the dissection. […] The goal of surgery is to obliterate entry into the false channel and reconstitute the aorta with a synthetic graft. If present, severe aortic regurgitation must be treated by resuspending the aortic leaflets or replacing the valve. Surgical outcomes are best with early, aggressive intervention. Mortality rates are approximately 20%. Predictors of poor outcome include […] Hypotension […] Renal failure […] Age 70 years […] Abrupt onset of chest pain […] Pulse deficit […] ST-segment elevation on ECG […] Stent grafts that seal entry to the false lumen and improve patency of the true lumen, balloon fenestration (in which an opening is made in the dissection flap that separates the true and false lumina), or both may be less invasive alternatives for patients with type B dissection if peripheral ischemic complications develop. Some endovascular devices (Gore Ascending Stent Graft) are available for compassionate use in patients with type A dissections who have contraindications to open surgical repair.

• #30 Aortic Dissection (Type A, Type B and Chronic Dissection) | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/aortic-dissection-type-type-b-and-chronic-dissection

  Malperfusion syndrome, or lack of blood supply to vital organs, is the second most common lethal complication of acute aortic dissection following rupture. It occurs in 10% to 33% of all cases of both acute type A and type B dissection. Early diagnosis is essential. […] Endovascular treatment for Type A aortic dissection are a relatively new and evolving approach to managing this life-threatening condition. […] The primary treatment for Type A aortic dissection is typically surgical repair. However, before surgery can be performed, initial medical management may be crucial to stabilize the patient and manage pain. […] Medical management of Type B aortic dissections aims to stabilize the patient’s condition, control blood pressure, and reduce the risk of complications. […] The decision to proceed with surgery for Type B aortic dissections is based on various factors, including the patient’s clinical condition, the extent of the dissection, the presence of complications, and individualized assessments by the medical team. […] Medical management of chronic aortic dissections is focused on long-term care and aims to prevent complications, reduce symptoms, and maintain overall cardiovascular health.

• #31 Aortic dissection – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-dissection/diagnosis-treatment/drc-20369499

  Medications. The same medications that are used to treat type A aortic dissection may be used without surgery to treat type B aortic dissections. […] Surgery. The procedure is similar to that used to correct a type A aortic dissection. Sometimes stents small wire mesh tubes that act as a sort of scaffolding may be placed in the aorta to repair complicated type B aortic dissections. […] After treatment, you may need to take medication to control your blood pressure for the rest of your life. You may need regular CT scans or MRI scans to monitor your condition.

• #32 Management of acute type B aortic dissection – UpToDate

  https://www.uptodate.com/contents/management-of-acute-type-b-aortic-dissection

  Management of acute type B aortic dissection […] The goals of initial medical management of acute type B aortic dissection are to control pain and limit the extension of the dissection using anti-impulse therapy. We agree with major interdisciplinary guidelines that generally suggest reserving intervention (surgical or endovascular) for those who develop complications related to the dissection (eg, dissection extension, malperfusion, aneurysm formation, rupture, persistent pain). […] The management of type A aortic dissection and other acute aortic syndromes are discussed separately. […] Determining the location of the aortic dissection, duration since onset of symptoms/occurrence, severity of symptoms, and etiology are important, as these impact prognosis and management.

• #33 Aortic Dissection Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Overview

  https://emedicine.medscape.com/article/2062452-treatment

  Acute aortic dissection can be treated surgically or medically. In surgical treatment, the area of the aorta with the intimal tear is usually resected and replaced with a Dacron graft. […] Emergency surgical correction is the preferred treatment for Stanford type A (DeBakey type I and II) ascending aortic dissection. It is also preferred for complicated Stanford type B (DeBakey type III) aortic dissections with clinical or radiologic evidence of the following conditions: […] Medical management remains the treatment of choice for descending aortic dissections unless they are leaking or ruptured. With the progress in stenting technology, descending dissections can be approached with this modality in selected cases. […] Medical therapy is also administered to surgical patients preoperatively, intraoperatively, and postoperatively to prevent progression or recurrence of aortic dissection.

• #34 Medical management in type B aortic dissection – Suzuki- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/4188/5091

  Medical management is generally the preferred treatment for uncomplicated type B acute aortic dissection cases. It is often centered on the use of antihypertensive agents, which alleviates hemodynamic stress on the damaged aortic wall. […] The aim of treatment in aortic dissection is to limit propagation of the false lumen and its negative consequences on end-organ perfusion by reducing and stabilizing hemodynamic stress on the aortic wall. […] Medical management of aortic dissection is still based mainly on personal experience, expert opinion and historical observational studies as there is a paucity of randomized controlled studies. […] In regards to specific anti-hypertensive agents, intravenous use of nicardipine, nitroglycerin and diltiazem in combination with beta-blockers was recommended.

• #35 Medical management in type B aortic dissection – Suzuki- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/4188/5091

  Furthermore, uncomplicated type B dissections have a 30-day mortality rate of less than 10%, a rate which is comparable to surgical outcomes, and therefore medical treatment is appropriate in the acute phase. […] The American Heart Association/American College of Cardiology (AHA/ACC) guidelines were published in 2010 and classify aortic dissection among the acute aortic syndromes. […] Initial medical stabilization using beta-blockers was recommended to control aortic wall stress that is affected by the velocity of ventricular contraction, the rate of ventricular contraction, and blood pressure parameters. […] Following initial stabilization with intravenous antihypertensives, most patients will require long-term antihypertensive treatment including the use of a beta-blocker plus additional classes of agents. […] Recent society guidelines and findings from global registry databases (e.g., IRAD) have made significant contributions to our approach to medical management of acute type B aortic dissection.

• #36 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  Complications of surgery include death, stroke (due to emboli), paraplegia (due to spinal cord ischemia), acute renal failure (especially if dissection includes renal arteries) and endoleak (leakage of blood back into the aneurysmal sac). […] The most important late sequellae include redissection, formation of localized aneurysms in the weakened aorta, and progressive aortic regurgitation. These complications may require surgical or endovascular repair. […] Long-term management […] All patients, including those treated by surgery or endovascular methods, are given long-term antihypertensive therapy, usually including beta-blockers, nondihydropyridine calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors. Almost any combination of antihypertensives is acceptable; exceptions are those that act mainly by vasodilation (eg, hydralazine, minoxidil) and beta-blockers that have intrinsic sympathomimetic action (eg, acebutolol, pindolol). Avoidance of strenuous physical activity is often recommended.

• #37 Medical management in type B aortic dissection – Suzuki- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/4188/5091

  Furthermore, uncomplicated type B dissections have a 30-day mortality rate of less than 10%, a rate which is comparable to surgical outcomes, and therefore medical treatment is appropriate in the acute phase. […] The American Heart Association/American College of Cardiology (AHA/ACC) guidelines were published in 2010 and classify aortic dissection among the acute aortic syndromes. […] Initial medical stabilization using beta-blockers was recommended to control aortic wall stress that is affected by the velocity of ventricular contraction, the rate of ventricular contraction, and blood pressure parameters. […] Following initial stabilization with intravenous antihypertensives, most patients will require long-term antihypertensive treatment including the use of a beta-blocker plus additional classes of agents. […] Recent society guidelines and findings from global registry databases (e.g., IRAD) have made significant contributions to our approach to medical management of acute type B aortic dissection.

• #38 Endovascular management of acute aortic dissection – Khayat – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/17500/html

  Uncomplicated type B aortic dissections can often be managed with medical therapy alone. […] Nonetheless, pre-emptive thoracic endovascular intervention [thoracic endovascular aortic repair (TEVAR)] is increasingly being used for uncomplicated dissection to avert late complications, such as aneurysmal false lumen degeneration and delayed rupture. […] For complicated type B aortic dissections, endovascular repair has become the principal modality of treatment, given the excess mortality of open repair. […] Placement of a stent-graft to cover the primary tear in anatomically suitable candidates maintains patency of the true lumen and in ideal cases causes depressurization and subsequent thrombosis of the false lumen. […] Interventionalists have multiple therapeutic endovascular options at their disposal for the treatment of aortic dissection, including dissection flap fenestration, stent graft placement, branch vessel stenting, or a combination of these techniques.

• #39 Cover Story | Interventional Management in Acute Type B and Type A Aortic Dissection

  https://www.acc.org/Latest-in-Cardiology/Articles/2021/03/01/01/42/Cover-Story-Interventional-Management-in-Acute-Type-B-and-Type-A-Aortic-Dissection

  TEVAR for uncomplicated TBAD holds promise to improve long-term aortic outcomes and is the subject of international investigation. […] Endovascular stenting of the descending aorta has evolved as the first-choice treatment option for complicated TBAD. […] TEVAR for complicated TBAD has led to less morbidity and mortality when compared to open surgical results. […] While this endovascular strategy now represents the current preferred first-line therapy for complicated TBAD, several key considerations remain unresolved. […] The rationale for and timing of TEVAR in TBAD generally incorporate the following considerations: duration of time from symptom onset, location of the proximal entry tear, aortic dimensions in the proximal and distal landing zones, segmental anatomic extent involved in the dissection, associated complications from the dissection (e.g., rupture vs. malperfusion), false lumen (FL) status.

• #40 Aortic Dissection Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Overview

  https://emedicine.medscape.com/article/2062452-treatment

  Surgical management of acute type B aortic dissections is undertaken only in the presence of indications such as the following: […] Patients without such indications are treated with intensive medical therapy. […] Intramural hematomas and penetrating atherosclerotic ulcers of the aorta are conditions that result in aortic dissection or rupture. Both are more common in the descending aorta; medical therapy is first-line treatment. […] Consider surgery in patients with penetrating atherosclerotic ulcers who are hemodynamically unstable or who have evidence of pseudoaneurysm formation or transmural rupture. Other indications for surgery include recurrent pain, distal embolization, and progressive aneurysmal dilatation from the ulcer. […] Once a thoracic dissection is suspected, consult a thoracic surgeon. […] Provide the following long-term care for patients with aortic dissection, whether treated medically or surgically:

• #41 Management of acute aortic dissection and thoracic aortic rupture | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0287-7

  In most patients with type B aortic dissection, medical therapy including analgesia, antihypertensive drugs, and bed rest is performed. However, complicated type B aortic dissection, such as descending aortic rupture, uncontrolled pain, and malperfusion of the aortic branch or lower extremities, is an indication for urgent surgery. The aim of surgical repair in patients with type B aortic dissection is to resect the primary entry tear and to replace the dissected descending aorta, which increases blood flow to the true lumen and improves organ ischemia. […] More recently, thoracic endovascular aortic repair (TEVAR) has become an alternative technique to treat complicated type B aortic dissection. The main goal of TEVAR is closure of the primary entry tear in the descending aorta. Blood flow is redirected into the true lumen, leading to improved distal perfusion by resolving malperfusion of visceral or limb arteries. Another aim of TEVAR is to stabilize the dissected aorta to prevent late complications by inducing aortic remodeling. Thrombosis of the false lumen may result in shrinkage and prevent aneurysmal degeneration; however, TEVAR remains limited in complicated cases because of a lack of evidence.

• #42 Aortic dissection – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/aortic-dissection/

  Treatment options range from conservative measures (e.g., blood pressure optimization) to surgery (aortic stent graft), depending on the localization and severity of the dissection. […] Stanford A dissection: immediate surgery. Stanford B dissection: treat conservatively; (watchful waiting and ongoing medical therapy) unless complications occur. […] Blood pressure control: essential in all patients to prevent progression of the dissection. […] Surgical therapy: All patients with Stanford A dissection. Patients with Stanford B dissection who develop complications: End-organ damage (ischemia), Hypotension, Persistent severe chest pain or hypertension, Propagation of dissection, Expanding aneurysm, Expanding hematoma, Rupture. […] Open surgery with the replacement of the dissection with a polyester graft implantation. Endovascular treatment; with aortic stent implantation (only in type B dissections and if the open operative risk is too high).

• #43 Care for the patient with aortic dissection | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/cardiovascular-intensive-care/Chapter-854/care-patient-aortic-dissection

  Alternatively, esmolol, verapamil, diltiazem […] Once contractility and rate control is achieved, vasodilators can also be used (nitroprusside, clevidipine, etc) […] Analgesia +/- sedation to decrease sympathetic output […] Endpoints of therapy: […] Systolic blood pressure <110 mmHg [...] HR < 70 [...] Improved surrogate measures of organ perfusion [...] Clinical indications for surgery: [...] "complicated" type B dissection: [...] Features suggesting instability: [...] Refractory hypertension [...] Ischaemia: [...] Visceral and renal ischaemia [...] Lower extremities ischaemia [...] Spinal cord ischaemia [...] Malperfusion: [...] Paraparesis or paraplegia [...] Abdominal pain, nausea, or diarrhea [...] Renal failure or LFT derangement [...] Radiological indications for surgery:

• #44 Aortic dissection – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-dissection/diagnosis-treatment/drc-20369499

  Medications. The same medications that are used to treat type A aortic dissection may be used without surgery to treat type B aortic dissections. […] Surgery. The procedure is similar to that used to correct a type A aortic dissection. Sometimes stents small wire mesh tubes that act as a sort of scaffolding may be placed in the aorta to repair complicated type B aortic dissections. […] After treatment, you may need to take medication to control your blood pressure for the rest of your life. You may need regular CT scans or MRI scans to monitor your condition.

• #45 Management of acute aortic dissection and thoracic aortic rupture | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0287-7

  In most patients with type B aortic dissection, medical therapy including analgesia, antihypertensive drugs, and bed rest is performed. However, complicated type B aortic dissection, such as descending aortic rupture, uncontrolled pain, and malperfusion of the aortic branch or lower extremities, is an indication for urgent surgery. The aim of surgical repair in patients with type B aortic dissection is to resect the primary entry tear and to replace the dissected descending aorta, which increases blood flow to the true lumen and improves organ ischemia. […] More recently, thoracic endovascular aortic repair (TEVAR) has become an alternative technique to treat complicated type B aortic dissection. The main goal of TEVAR is closure of the primary entry tear in the descending aorta. Blood flow is redirected into the true lumen, leading to improved distal perfusion by resolving malperfusion of visceral or limb arteries. Another aim of TEVAR is to stabilize the dissected aorta to prevent late complications by inducing aortic remodeling. Thrombosis of the false lumen may result in shrinkage and prevent aneurysmal degeneration; however, TEVAR remains limited in complicated cases because of a lack of evidence.

• #46 Endovascular management of acute aortic dissection – Khayat – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/17500/html

  Uncomplicated type B aortic dissections can often be managed with medical therapy alone. […] Nonetheless, pre-emptive thoracic endovascular intervention [thoracic endovascular aortic repair (TEVAR)] is increasingly being used for uncomplicated dissection to avert late complications, such as aneurysmal false lumen degeneration and delayed rupture. […] For complicated type B aortic dissections, endovascular repair has become the principal modality of treatment, given the excess mortality of open repair. […] Placement of a stent-graft to cover the primary tear in anatomically suitable candidates maintains patency of the true lumen and in ideal cases causes depressurization and subsequent thrombosis of the false lumen. […] Interventionalists have multiple therapeutic endovascular options at their disposal for the treatment of aortic dissection, including dissection flap fenestration, stent graft placement, branch vessel stenting, or a combination of these techniques.

• #47 Evolving Treatments for Aortic Dissection – Endovascular Today

  https://evtoday.com/articles/2016-mar/evolving-treatments-for-aortic-dissection

  Aortic dissection is the most common aortic catastrophe, with dynamic pathology and high rates of morbidity and mortality if left untreated. Successful management mandates high clinical suspicion, prompt diagnosis, accurate assessment of aortic anatomy, and long-term surveillance. Patients with uncomplicated dissections have traditionally been treated with medical therapy that involves managing blood pressure and controlling pain. Operative intervention is reserved for complicated scenarios, including rupture, malperfusion syndrome, rapidly enlarging aortic diameter, progression of the dissection, intractable pain, and/or hypertension. […] TEVAR has rapidly become the preferred approach at most centers for treatment of distal aortic dissections. The treatment goals are to cover the entry tear, promote thrombosis of the false lumen, and facilitate aortic remodeling. Technical success in most cases reestablishes flow to the true lumen and restores perfusion to the viscera, kidneys, and lower limbs. In our case, the stent graft restored patency to the patients celiac artery, as demonstrated by IVUS, and her symptoms improved.

• #48 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  The type and location of the dissection classified by the Stanford or DeBakey systems determine the need for surgical or medical intervention. […] Type A dissections are considered surgical emergencies due to the risk of catastrophic complications such as cardiac tamponade, severe aortic regurgitation, myocardial infarction, or aortic rupture. Surgical mortality varies from 5% to 20%. Surgical intervention involves: Excision of the intimal tear, Aortic replacement, Aortic valve assessment and repair/replacement. […] Uncomplicated type B dissections are typically managed with aggressive blood pressure and heart rate control. The goal is to reduce aortic wall stress, prevent progression, and monitor for complications. […] Endovascular stent-grafting is preferred for complicated type B dissections. TEVAR involves placing a stent-graft to seal the dissection entry tear and exclude the false lumen, promoting healing and remodeling of the aorta. TEVAR is associated with significantly lower morbidity and mortality compared to open surgical repair.

• #49 Cover Story | Interventional Management in Acute Type B and Type A Aortic Dissection

  https://www.acc.org/Latest-in-Cardiology/Articles/2021/03/01/01/42/Cover-Story-Interventional-Management-in-Acute-Type-B-and-Type-A-Aortic-Dissection

  Despite these anatomical and technical challenges, a few purpose-built devices have been designed and used specifically for ascending aortic endovascular repair. […] Due to technological and procedural advances, interventional therapy has become the preferred method of treating acute complications of Type B aortic dissection leading to lower morbidity and mortality compared to emergency open surgery.

• #50 Endovascular management of acute aortic dissection – Khayat – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/17500/html

  Uncomplicated type B aortic dissections can often be managed with medical therapy alone. […] Nonetheless, pre-emptive thoracic endovascular intervention [thoracic endovascular aortic repair (TEVAR)] is increasingly being used for uncomplicated dissection to avert late complications, such as aneurysmal false lumen degeneration and delayed rupture. […] For complicated type B aortic dissections, endovascular repair has become the principal modality of treatment, given the excess mortality of open repair. […] Placement of a stent-graft to cover the primary tear in anatomically suitable candidates maintains patency of the true lumen and in ideal cases causes depressurization and subsequent thrombosis of the false lumen. […] Interventionalists have multiple therapeutic endovascular options at their disposal for the treatment of aortic dissection, including dissection flap fenestration, stent graft placement, branch vessel stenting, or a combination of these techniques.

• #51

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-cardiovascular/thoracic-aortic-dissection

  Though the majority of type B aortic dissections do not require immediate surgical management, certain features render them complicated. When end-organ perfusion is compromised (e.g., intestinal ischemia, spinal cord ischemia, renal malperfusion), hypertension is refractory to medications, the dissection continues to propagate despite medical interventions, or the aorta exhibits aneurysmal expansion, open surgical or endovascular procedures may be indicated. Sometimes these conditions are evident at the time of emergency department presentation; alternatively, these complications can develop years after the initial dissection or at any time in between. Among patients taken for open surgical intervention, mortality approaches one-third; however, more recent experience with endovascular techniques has reduced mortality to as low as 5%.

• #52 Aortic dissection – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_dissection

  Indications for the surgical treatment of aortic dissection include an acute proximal aortic dissection and an acute distal aortic dissection with one or more complications. […] The objective in the surgical management of aortic dissection is to resect (remove) the most severely damaged segments of the aorta and to obliterate the entry of blood into the false lumen (both at the initial intimal tear and any secondary tears along the vessel). […] Open aortic surgery with replacement of the damaged section of the aorta with a tube graft (often made of Dacron) when no damage to the aortic valve is seen. […] Thoracic endovascular aortic repair, a minimally invasive surgical procedure usually combined with ongoing medical management.

• #53 Aortic dissection Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/aortic-dissection

  Aortic dissection is a life-threatening condition and needs to be treated right away. […] Dissections that occur in the part of the aorta that is leaving the heart (ascending) are treated with surgery. […] Dissections that occur in other parts of the aorta (descending) may be managed with surgery or medicines. […] Two techniques may be used for surgery: Standard, open surgery. This requires a surgical incision that is made in the chest or abdomen. […] Endovascular aortic repair. This surgery is done without any major surgical incisions. […] Medicines that lower blood pressure may be prescribed. These medicines may be given through a vein (intravenously). Beta-blockers are the medicines of first choice. Strong pain relievers are very often needed. […] If the aortic valve is damaged, valve replacement is needed. If the heart arteries are involved, a coronary bypass is also performed.

• #54 Aortic Dissection: Causes, Symptoms & Treatment | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/conditions/aortic-dissection-type-a-and-type-b

  Aortic dissection is a life-threatening condition and needs to be treated right away. Surgery is necessary for most Type A dissections, but medications such as beta blockers and nitroprusside may be prescribed to reduce the heart rate and lower blood pressure to prevent aortic dissection from worsening in an effort to stabilize blood pressure prior to surgery. […] Type B dissections may be treated with surgery or with the same medications used for those with type A without surgery. There are two surgical techniques used: Open chest or abdominal surgery requiring an incision made in the chest or abdomen. […] Endovascular surgery to repair the aorta which is performed without major surgical incisions using thoracic stent-grafts inserted through the femoral artery in the groin. […] For patients with type A dissection, 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 (graft).

• #55 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=135&contentid=72

  Aortic dissection is a medical emergency. Early diagnosis and treatment are important. […] You will need surgery if the tear is on the ascending aorta. This is the part of the aorta that goes up through your chest toward your head. […] A surgeon must repair this as soon as possible. […] There are two possible surgery methods for aortic dissection repair. The first is standard open-heart surgery. The second is less invasive endovascular surgery. […] Your surgeon will make a cut (incision) in your chest or belly (abdomen). The exact spot will depend on where your dissection is located. […] Your surgeon will attach a synthetic graft to the end of a tube (catheter). […] Surgery to repair an aortic dissection is very complicated. […] You may need at least a month to recover from your surgery.

• #56 Open Surgery Treatment of an Aortic Dissection | Society for Vascular Surgery

  https://vascular.org/your-vascular-health/your-care-journey/treatments/open-surgery-treatment-aortic-dissection

  A dissection that involves the ascending aorta almost always requires emergency open-heart surgery to repair the vessel and prevent death. […] Whether endovascular or open surgery treatment is best for you depends on multiple factors, including the anatomy of the dissection, your age and health condition. […] If open surgery treatment is appropriate, one of the two procedures below will likely be recommended. […] This procedure is done to improve blood flow to the arteries that feed the abdominal organs and kidneys, and sometimes the pelvis and legs. […] For about 30-40% of patients with an aortic dissection, over time, the aortic wall will dilate and form an aneurysm. […] When such an aneurysm grows to more than 6 cm in diameter, it will likely need repair through open aortic reconstruction.

• #57 Aortic Dissection: Symptoms, Types, Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/aortic-dissection

  Aortic dissection requires immediate care. Without prompt treatment, it could result in sudden death. […] Less severe cases may be treated with medication until complications develop, but for most aortic dissections, surgery is the only solution. Type A dissections require immediate emergency surgery, while Type B dissections require urgent or emergency surgery, depending on severity. […] Surgeons use two main procedures to treat aortic dissection: Endovascular repair: This technique is a minimally invasive procedure that uses small incisions to allow the surgeon to insert a tiny tube into your blood vessel and deliver a repair patch called a stent to the site of the tear. Replacement: In graft replacement, surgeons replace the damaged portion of the aorta with a synthetic tube. […] Sometimes, the surgeon will mix the two types of surgery, especially in two-stage procedures where the tear can’t be repaired in a single surgery.

• #58 Acute Aortic Dissection • LITFL • CCC Cardiology

  https://litfl.com/acute-aortic-dissection/

  dissection and clamps may interfere with arterial monitoring […] TXA2 […] femoral arterial cannulation used for bypass […] anticoagulate before bypass […] if aortic root involved then patient may need AVR with coronary artery reimplantation […] monitor BP after bypass closely […] may have dissected into other organs (monitor function) […] Circulatory Arrest […] deep hypothermic arrest (DHA) required during arch surgery as it isnt possible to perfuse cerebral vessels on bypass […] safe duration = 45min @ 18 C […] other ways of protecting brain; pack head with ice, thiopentone, methylprednisonlone mannitol, GTN (to prevent vasoconstriction) […] POCD proportional to DHA time […] once circulation arrested – all infusion and pumps stopped […] when warming do not set FAW to 10 C (prevents burns), start propofol and fix coagulopathy with products

• #59 Open Surgery Treatment of an Aortic Dissection | Society for Vascular Surgery

  https://vascular.org/your-vascular-health/your-care-journey/treatments/open-surgery-treatment-aortic-dissection

  The stress to your body that this surgery causes brings risk for major complications that include death, stroke, heart attack, pneumonia, kidney failure, and damage to the colon or other organs due to insufficient blood supply. […] The likelihood of any specific side effect depends on your overall health, and should be discussed with your vascular surgeon. […] Expect to spend the postoperative period in the ICU. The average hospital stay is about 2 weeks. You will be monitored for potential complications and have time to recover physically.

• #60 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  The extent of repair depends upon the reason for repair and the anatomic nature of the dissection. […] The goal of surgery is to obliterate entry into the false channel and reconstitute the aorta with a synthetic graft. If present, severe aortic regurgitation must be treated by resuspending the aortic leaflets or replacing the valve. Surgical outcomes are best with early, aggressive intervention. Mortality rates are approximately 20%. Predictors of poor outcome include […] Hypotension […] Renal failure […] Age 70 years […] Abrupt onset of chest pain […] Pulse deficit […] ST-segment elevation on ECG […] Stent grafts that seal entry to the false lumen and improve patency of the true lumen, balloon fenestration (in which an opening is made in the dissection flap that separates the true and false lumina), or both may be less invasive alternatives for patients with type B dissection if peripheral ischemic complications develop. Some endovascular devices (Gore Ascending Stent Graft) are available for compassionate use in patients with type A dissections who have contraindications to open surgical repair.

• #61 Aortic Dissection Causes & Treatment | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/aortic-dissection

  During open aortic dissection, the vessel’s weakened section will be removed and replaced with a graft of artificial material. If there is a leak in the aortic valve (the valve that regulates blood flow from the heart into the aorta), a valve replacement may also be recommended during the procedure. […] During endovascular aortic dissection surgery, a stent graft is positioned inside the diseased section of the aorta. The stent acts as a liner to form a stable channel for blood flow. […] Depending on how your body heals, you will be in the hospital for up to 10 days after open surgery and it may be three to six months before you fully resume your normal activities. After endovascular surgery, you will be in the hospital for a few days and it may be four to six weeks before you fully recover.

• #62 Aortic dissection Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/aortic-dissection

  Aortic dissection is a life-threatening condition and needs to be treated right away. […] Dissections that occur in the part of the aorta that is leaving the heart (ascending) are treated with surgery. […] Dissections that occur in other parts of the aorta (descending) may be managed with surgery or medicines. […] Two techniques may be used for surgery: Standard, open surgery. This requires a surgical incision that is made in the chest or abdomen. […] Endovascular aortic repair. This surgery is done without any major surgical incisions. […] Medicines that lower blood pressure may be prescribed. These medicines may be given through a vein (intravenously). Beta-blockers are the medicines of first choice. Strong pain relievers are very often needed. […] If the aortic valve is damaged, valve replacement is needed. If the heart arteries are involved, a coronary bypass is also performed.

• #63

  https://www.cookmedical.com/patient-resources/aortic-dissection/aortic-dissection-treatment-options/

  Endovascular repair is an alternative to open surgical repair. Instead of making a large cut in the chest, the doctor makes a small cut near the hip to access the femoral arteries, a large blood vessel in your thigh. Through these small cuts, an endovascular graft is inserted into the femoral artery through a delivery catheter, which allows it to travel to the aorta. Once it has been positioned in the aorta, the graft seals off the area where the tear begins and makes a new path for the blood to flow through. Below the endovascular graft, an endovascular stent a self-expanding metal stent that is not covered in fabric may be placed to gently reinforce the aorta and support the layers of the aortic wall. The graft and stent remain inside the aorta permanently. […] Open surgical repair and endovascular repair are not options for every patient. Both types of repair have pros and cons. The best repair will depend on your condition and needs. Talk about the pros and cons with your doctor. […] Remember, every patient is different, and your doctor knows you best. After reading the information on this site, make an appointment to talk to your doctor to help you make the right decision about any treatments or procedures.

• #64 Endovascular Treatment of an Aortic Dissection | Society for Vascular Surgery

  https://vascular.org/your-vascular-health/your-care-journey/treatments/endovascular-treatment-aortic-dissection

  A dissection that involves the ascending aorta almost always requires emergency open-heart surgery to repair the vessel and prevent death. ONLY ENDOVASCULAR TREATMENTS for distal dissections occurring beyond the left subclavian artery (feeds the left arm) are described here. […] Whether endovascular or open surgery treatment is best for you depends on multiple factors, including the anatomy of the dissection, and your age and health condition. […] If endovascular treatment is appropriate, one of the two procedures below will likely be recommended. […] This is a minimally invasive treatment for an aortic dissection or aneurysm. In the case of a dissection, a cloth-covered stent graft is used to seal the tear in the aorta. […] This is done to improve blood flow to a specific branch artery or to help equalize pressure between the true and false lumens.

• #65 Aortic Dissection | Vascular Center | UC Davis Health

  https://health.ucdavis.edu/vascular/diseases/aortic_dissection.html

  Acute aortic dissection is an emergency requiring immediate treatment. The patient may be given medication to lower blood pressure and heart rate. Surgery may be required to repair the damage. […] Endovascular surgical repair (EVAR) is a less-invasive surgical treatment that involves a small incision in the groin and the insertion of a stent or stent graft through a catheter placed in the femoral artery. Physicians use X-ray imaging to guide the stent graft to the diseased area. The stent or stent graft is then expanded inside the aorta. Blood-flow is redirected to the correct channel of the aorta and back into the branches of the aorta. […] New techniques for repairing a dissection are still being developed. One such technique, called aortic fenestration, involves inserting a balloon catheter and inflating it to create a hole downstream of the original tear to allow blood to flow back into the aorta. These newer techniques are also available at the Vascular Center.

• #66 Types of Treatment for Aortic Dissection | MedStar Health

  https://www.medstarhealth.org/services/aortic-dissection-treatment

  The damaged aorta will be replaced with a long-lasting synthetic graft. […] Type A dissections also may damage the aortic root. […] 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.

• #67 Aortic Dissection Causes & Treatment | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/aortic-dissection

  During open aortic dissection, the vessel’s weakened section will be removed and replaced with a graft of artificial material. If there is a leak in the aortic valve (the valve that regulates blood flow from the heart into the aorta), a valve replacement may also be recommended during the procedure. […] During endovascular aortic dissection surgery, a stent graft is positioned inside the diseased section of the aorta. The stent acts as a liner to form a stable channel for blood flow. […] Depending on how your body heals, you will be in the hospital for up to 10 days after open surgery and it may be three to six months before you fully resume your normal activities. After endovascular surgery, you will be in the hospital for a few days and it may be four to six weeks before you fully recover.

• #68 Endovascular Treatment of an Aortic Dissection | Society for Vascular Surgery

  https://vascular.org/your-vascular-health/your-care-journey/treatments/endovascular-treatment-aortic-dissection

  Though the incidence of side effects and complications is low with both TEVAR and endovascular fenestration, there are risks to consider. […] If the procedure fails to adequately improve blood flow to artery branches, additional stents may need to be placed in the affected arteries. […] You can expect discomfort or pain, usually minimal, can occur at groin access sites.

• #69 Aortic dissection surgery – Lenox Hill Heart & Lung | Northwell Health

  https://lenoxhill.northwell.edu/lenox-hill-heart-lung/find-care/treatments/aortic-dissection-surgery

  Aortic dissection treatment includes a number of surgical options, from open surgery to minimally invasive procedures (endovascular). However, if the dissection involves the ascending aorta, emergency open-heart surgery is almost always required. […] If you are not a candidate for open-heart surgery, your surgeon may recommend endovascular surgery in its place. Endovascular surgery is also a popular treatment option for descending aortic dissection, which is not as life-threatening as a dissection in the ascending aorta. […] Aortic dissection surgery recovery requires a postoperative stay in the intensive care unit (ICU). On average, you can expect to be in the hospital for about two weeks during the initial recovery from the surgery. After the hospital stay, you may need an additional one to two weeks at a rehabilitation facility to build your strength back up.

• #70 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  The extent of repair depends upon the reason for repair and the anatomic nature of the dissection. […] The goal of surgery is to obliterate entry into the false channel and reconstitute the aorta with a synthetic graft. If present, severe aortic regurgitation must be treated by resuspending the aortic leaflets or replacing the valve. Surgical outcomes are best with early, aggressive intervention. Mortality rates are approximately 20%. Predictors of poor outcome include […] Hypotension […] Renal failure […] Age 70 years […] Abrupt onset of chest pain […] Pulse deficit […] ST-segment elevation on ECG […] Stent grafts that seal entry to the false lumen and improve patency of the true lumen, balloon fenestration (in which an opening is made in the dissection flap that separates the true and false lumina), or both may be less invasive alternatives for patients with type B dissection if peripheral ischemic complications develop. Some endovascular devices (Gore Ascending Stent Graft) are available for compassionate use in patients with type A dissections who have contraindications to open surgical repair.

• #71 Cover Story | Interventional Management in Acute Type B and Type A Aortic Dissection

  https://www.acc.org/Latest-in-Cardiology/Articles/2021/03/01/01/42/Cover-Story-Interventional-Management-in-Acute-Type-B-and-Type-A-Aortic-Dissection

  TEVAR for uncomplicated TBAD carries risks including retrograde dissection, stroke, spinal cord ischemia, post-implantation syndrome and continued perigraft flow. […] The timing of prophylactic aortic intervention is also important in treatment outcomes. […] While early interventions may provide advantages for aortic remodeling (when the dissection flap is most pliable), complications including retrograde dissection and SINE may be more common immediately after the acute dissection. […] Endovascular therapy for TAAD has been proposed as an alternative to open repair for selected patients. […] Successful stent graft deployment must also contend with not only the differential lengths of the inner and outer curves, but also the high shear force and wall tension generated by the close proximity to the left ventricle.

• #72 Endovascular Treatment of an Aortic Dissection | Society for Vascular Surgery

  https://vascular.org/your-vascular-health/your-care-journey/treatments/endovascular-treatment-aortic-dissection

  Though the incidence of side effects and complications is low with both TEVAR and endovascular fenestration, there are risks to consider. […] If the procedure fails to adequately improve blood flow to artery branches, additional stents may need to be placed in the affected arteries. […] You can expect discomfort or pain, usually minimal, can occur at groin access sites.

• #73 Aortic Dissections: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/aortic-aneurysm/aortic-dissections/treatment

  Hybrid approach – This approach uses open surgery with the endovascular stent graft to repair the aorta. This can be done during an emergency operation for type A dissection or as a two-step endovascular repair for type B dissection. […] Beta blockers Commonly prescribed to lower blood pressure and heart rate. […] People generally maintain a regime of blood pressure medications for the rest of their life. In addition, patients maintain regular appointments with their cardiologist to monitor the aortic dissection. […] It is important to recognize the symptoms of an aortic dissection. Aortic dissection is a serious condition that requires immediate medical treatment.

• #74 Management of chronic type B aortic dissection

  https://www.oaepublish.com/articles/2574-1209.2021.125

  The cornerstone of chronic medical therapy for CTBAD is anti-impulse therapy, with beta-blockers as a first-line agent. […] Studies have shown that long-term treatment with beta-blockers reduces the progression of aortic dilation, incidence of hospital admission, incidence of late aortic procedures, and cost of therapy when compared with other (non-beta-blocker) antihypertensive agents. […] Indications for intervention at smaller sizes may include rapid growth of the aneurysm ( 5 mm -10 mm in 12 months) or a saccular aneurysm protruding 2 cm or more beyond the aortic wall. […] CTBAD may be treated by endovascular, open surgical, or hybrid approaches. […] The objective of endovascular intervention is to cover the false lumen entry tears and promote false lumen thrombosis and positive aortic remodeling.

• #75 Management of acute aortic dissection and thoracic aortic rupture | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0287-7

  Maintaining the hemodynamic condition of patients with free aortic rupture is difficult. The majority of patients with aortic rupture and continuous bleeding cannot survive even with massive transfusion and large doses of catecholamine. However, the hemodynamic status of patients with a contained rupture is relatively near stable, although blood transfusion should be started as soon as possible after the diagnosis is established. Traditionally, patients with this condition have been treated by open repair. Total arch replacement with median sternotomy is performed when an aneurysm is located in the arch or distal arch segment. If the descending aortic aneurysm is accompanied by an arch aneurysm, hybrid procedures (combined endovascular and vascular surgery procedures) are used.

• #76 Management of chronic type B aortic dissection

  https://www.oaepublish.com/articles/2574-1209.2021.125

  TEVAR may offer a less morbid procedure and has been shown to be durable in the mid-term; however, the long-term durability of these devices is unknown. […] Open surgical intervention is the treatment of choice for patients with connective tissue disease or anatomy (typically TAAA) that is unsuitable for TEVAR. […] Hybrid procedures for CTBAD are diverse and can be tailored to the anatomy of a particular patient. […] Open and endovascular interventions for CTBAD are not without risk. […] After an open or endovascular intervention, aortic surveillance should continue for the lifetime of the patient. […] A systematic perioperative approach should be applied to manage any evidence of spinal cord compromise.

• #77 Aortic dissection – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-dissection/diagnosis-treatment/drc-20369499

  Medications. The same medications that are used to treat type A aortic dissection may be used without surgery to treat type B aortic dissections. […] Surgery. The procedure is similar to that used to correct a type A aortic dissection. Sometimes stents small wire mesh tubes that act as a sort of scaffolding may be placed in the aorta to repair complicated type B aortic dissections. […] After treatment, you may need to take medication to control your blood pressure for the rest of your life. You may need regular CT scans or MRI scans to monitor your condition.

• #78 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  Complications of surgery include death, stroke (due to emboli), paraplegia (due to spinal cord ischemia), acute renal failure (especially if dissection includes renal arteries) and endoleak (leakage of blood back into the aneurysmal sac). […] The most important late sequellae include redissection, formation of localized aneurysms in the weakened aorta, and progressive aortic regurgitation. These complications may require surgical or endovascular repair. […] Long-term management […] All patients, including those treated by surgery or endovascular methods, are given long-term antihypertensive therapy, usually including beta-blockers, nondihydropyridine calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors. Almost any combination of antihypertensives is acceptable; exceptions are those that act mainly by vasodilation (eg, hydralazine, minoxidil) and beta-blockers that have intrinsic sympathomimetic action (eg, acebutolol, pindolol). Avoidance of strenuous physical activity is often recommended.

• #79 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  CT may be done before discharge and repeated at 6 months and 1 year, and then every 1 to 2 years. […] After repair of a dissection, the aorta should be monitored for the rest of the patient’s life. The weakened aorta may develop aneurysmal degeneration above or below the surgical repair or re-dissect. For these reasons, continued surveillance is indicated.

• #80

  https://www2.hse.ie/conditions/aortic-dissection/treating-aortic-dissection/

  After the initial treatment for type A or type B, you may need to take medicine to lower your blood pressure. It is likely that you will remain on this medicine to control your blood pressure for the rest of your life. If you have had a new metal aortic valve you will need also to take Warfarin for the rest of your life. You should get regular checks with a specialist doctor, including CT or MRI scans. These are to monitor the aorta in case any further problems occur.

• #81 Aortic aneurysm, dissection and rupture – BHF

  https://www.bhf.org.uk/informationsupport/conditions/aortic-aneurysm-dissection-and-rupture

  Type B is a tear in the lower, descending part of the aorta and can go into the abdomen. The risk is less than for Type A and doesnt always require immediate surgery. Doctors may be able to keep the condition under control with the use of blood pressure lowering medicines. […] All people who have aortic dissection (including those treated surgically) will have to take medication to control their blood pressure, usually for the rest of their lives. The medication helps reduce stress on the aorta.

• #82 Management of chronic type B aortic dissection

  https://www.oaepublish.com/articles/2574-1209.2021.125

  The standard of care first-line therapy for uncomplicated acute type B aortic dissection is medical therapy. […] With proper medical management, surveillance, and intervention, CTBAD can be managed effectively and downstream morbidity minimized. […] In the past, open surgical management was the treatment of choice when intervention was required for chronic type B aortic dissections (CTBAD). […] Since then, thoracic endovascular aortic repair (TEVAR) has become an important component in the management of CTBAD, either as a stand-alone therapy or combined with open surgery in a hybrid manner. […] Life-long clinical and imaging surveillance of patients with known aortic dissection is necessary to identify those who may require intervention to prevent aortic catastrophe, as well as to monitor for complications after a successful repair.

• #83 Aortic dissection symptoms, diagnosis and treatment | Nebraska Medicine Omaha, NE

  https://www.nebraskamed.com/health/conditions-and-services/heart-and-vascular/aortic-dissection-symptoms-diagnosis-and

  Treatment depends upon the location of the tear and dissection […] Type A dissection requires immediate, complex surgery to remove and replace the part of the blood vessel that is torn, as the most life-threatening part is closest to the heart. When promptly treated, surgery offers an 80 to 90% survival rate. While surgery can significantly improve survival chances, risks and potential long-term impacts remain. Long-term follow-up is necessary, including regular CT scans. […] Type B dissection may need surgery urgently if the tear cuts off the blood flow to vital organs. However, other organs are more commonly not involved, so this type is usually managed conservatively initially. […] When dealing with Type B, we manage the pain, control the blood pressure, and monitor them closely, says Dr. Siddique. In the long term, many patients’ aorta changes over time; in particular, it may become enlarged aneurysmal. A third of patients require surgery in the long term due to these changes. Some patients may benefit from pre-emptive early surgery in cases where the dissection has concerning features for future enlargement. Therefore, patients must be followed long term with regular CT scans, especially in the first five years after the dissection. […] Preventive measures focus on factors that can be changed, such as controlling blood pressure, avoiding smoking and practicing a healthy lifestyle.

• #84 Aortic Dissection | UCSF Department of Surgery

  https://surgery.ucsf.edu/condition/aortic-dissection

  Aortic dissection generally appears as a hypertensive emergency, and the prime consideration of medical management is strict blood pressure control. Beta blockers are a first line treatment for patients with acute and chronic aortic dissection. Vasodilators such as sodium nitroprusside can be considered for patients with ongoing hypertension, but they should never be used alone, as they generally cause reflex tachycardia.

• #85 Aortic Dissection | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20603

  Lifelong antihypertensive therapy is indicated to maintain a systolic blood pressure of less than 120 mm Hg. […] Regular imaging follow-up with CT, MRI, or echocardiography is critical to monitor for aneurysm formation, residual dissection, or complications like endoleaks. […] Patients should be educated about the various modifiable and non-modifiable risk factors contributing to AAD’s development. […] Early recognition of AAD symptoms is critical for timely intervention and reducing mortality.

• #86 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  Complications of surgery include death, stroke (due to emboli), paraplegia (due to spinal cord ischemia), acute renal failure (especially if dissection includes renal arteries) and endoleak (leakage of blood back into the aneurysmal sac). […] The most important late sequellae include redissection, formation of localized aneurysms in the weakened aorta, and progressive aortic regurgitation. These complications may require surgical or endovascular repair. […] Long-term management […] All patients, including those treated by surgery or endovascular methods, are given long-term antihypertensive therapy, usually including beta-blockers, nondihydropyridine calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors. Almost any combination of antihypertensives is acceptable; exceptions are those that act mainly by vasodilation (eg, hydralazine, minoxidil) and beta-blockers that have intrinsic sympathomimetic action (eg, acebutolol, pindolol). Avoidance of strenuous physical activity is often recommended.

• #87 Aortic Dissection Repair | Heart and Vascular Center | DHMC and Clinics

  https://www.dartmouth-hitchcock.org/heart-vascular/aortic-dissection-repair

  The benefits of a successful repair are many, with the majority of surviving patients returning to full productivity. Patients usually need to take medication for the rest of their life to control their blood pressure, so as to minimize pressure on the wall of their aorta. Close, long-term follow-up of such patients is also advisable, to watch for the development of complications or further dissections. Up to 30% of patients may require another operation to repair a subsequent dissection or aneurysm of their aorta.

• #88 Aortic Dissection Causes & Treatment | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/aortic-dissection

  During open aortic dissection, the vessel’s weakened section will be removed and replaced with a graft of artificial material. If there is a leak in the aortic valve (the valve that regulates blood flow from the heart into the aorta), a valve replacement may also be recommended during the procedure. […] During endovascular aortic dissection surgery, a stent graft is positioned inside the diseased section of the aorta. The stent acts as a liner to form a stable channel for blood flow. […] Depending on how your body heals, you will be in the hospital for up to 10 days after open surgery and it may be three to six months before you fully resume your normal activities. After endovascular surgery, you will be in the hospital for a few days and it may be four to six weeks before you fully recover.

• #89 Aortic Dissection: Symptoms, Types, Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/aortic-dissection

  Immediate care is crucial to a good outcome. If you delay treatment until after the aorta ruptures, your chances of survival are less than 50%. For those who get treatment in time, the early mortality rate is still between 9-25%. […] Even with successful surgery, life expectancy after an aortic dissection is shorter than for the general population. You’ll also need ongoing monitoring for the rest of your life, with regular heart scans every few months. […] No. Getting immediate treatment for an aortic dissection is vital.

• #90 Cover Story | Interventional Management in Acute Type B and Type A Aortic Dissection

  https://www.acc.org/Latest-in-Cardiology/Articles/2021/03/01/01/42/Cover-Story-Interventional-Management-in-Acute-Type-B-and-Type-A-Aortic-Dissection

  Acute aortic dissection may be life-threatening and initial therapy includes stabilization, anti-impulse blood pressure control with beta-blocker, urgent surgery for Type A (ascending proximal to the brachiocephalic artery) dissection and optimal medical therapy (and intervention for complications) for Type B (not involving the ascending aorta, typically distal to the left subclavian artery) dissection. Optimal medical therapy includes reducing the systolic blood pressure to 120 mm Hg and heart rate to 70 beats/minute. […] Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for acute complicated TBAD and may correct malperfusion and treat enlarging aneurysms and acute rupture, with open surgery reserved for those not treatable by endovascular techniques. […] TEVAR, by covering the primary tear and directing the blood flow into the true lumen, promotes false lumen thrombosis, slows dilatation of the downstream aorta and allows aortic remodeling.

• #91 Cover Story | Interventional Management in Acute Type B and Type A Aortic Dissection

  https://www.acc.org/Latest-in-Cardiology/Articles/2021/03/01/01/42/Cover-Story-Interventional-Management-in-Acute-Type-B-and-Type-A-Aortic-Dissection

  TEVAR for uncomplicated TBAD holds promise to improve long-term aortic outcomes and is the subject of international investigation. […] Endovascular stenting of the descending aorta has evolved as the first-choice treatment option for complicated TBAD. […] TEVAR for complicated TBAD has led to less morbidity and mortality when compared to open surgical results. […] While this endovascular strategy now represents the current preferred first-line therapy for complicated TBAD, several key considerations remain unresolved. […] The rationale for and timing of TEVAR in TBAD generally incorporate the following considerations: duration of time from symptom onset, location of the proximal entry tear, aortic dimensions in the proximal and distal landing zones, segmental anatomic extent involved in the dissection, associated complications from the dissection (e.g., rupture vs. malperfusion), false lumen (FL) status.

• #92 Antiplatelet Therapy for Extensive Repaired Type A Aortic Dissection – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/news/antiplatelet-therapy-for-extensive-repaired-type-a-aortic-dissection/

  Antiplatelet therapy may be administered as indicated for extensive repaired TAAD as it does not affect long-term outcomes. […] Extensive repaired type A aortic dissection (TAAD) can be treated efficaciously and safely as needed with antiplatelet therapy, according to findings published in the European Journal of Cardio-Thoracic Surgery. […] Antiplatelet therapy can be administered as indicated on extensive repaired TAAD. […] Antiplatelet therapy did not impact long-term DTA FL thrombosis, redilation, reintervention or rupture, MBEs or overall survival on extensive repaired TAAD, the investigators wrote. Antiplatelet therapy can be administered as indicated on extensive repaired TAAD.

• #93 Evolving Treatments for Aortic Dissection – Endovascular Today

  https://evtoday.com/articles/2016-mar/evolving-treatments-for-aortic-dissection

  Endovascular repair has become the initial choice of treatment for acute uncomplicated and complicated DeBakey type III dissections and may have the potential to further shift treatment paradigms for ascending aortic dissections as the technology evolves. We have presented our management approach of an acute, complicated, DeBakey type IIIB dissection using IVUS and the Medtronic Valiant stent graft to reexpand the true lumen, promote thrombosis of the false lumen, and restore flow to the mesenteric vessels. These technologies should be in the armamentarium of endovascular surgeons and interventionists who treat aortic dissections.

• #94 Cover Story | Interventional Management in Acute Type B and Type A Aortic Dissection

  https://www.acc.org/Latest-in-Cardiology/Articles/2021/03/01/01/42/Cover-Story-Interventional-Management-in-Acute-Type-B-and-Type-A-Aortic-Dissection

  Despite these anatomical and technical challenges, a few purpose-built devices have been designed and used specifically for ascending aortic endovascular repair. […] Due to technological and procedural advances, interventional therapy has become the preferred method of treating acute complications of Type B aortic dissection leading to lower morbidity and mortality compared to emergency open surgery.

• #95 Aortic dissection – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-dissection/diagnosis-treatment/drc-20369499

  An aortic dissection is a medical emergency requiring immediate treatment. Treatment may include surgery or medications, depending on the area of the aorta involved. […] Treatment for type A aortic dissection may include: […] Surgery. Surgeons remove as much of the dissected aorta as possible and stop blood from leaking into the aortic wall. A synthetic tube (graft) is used to reconstruct the aorta. 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. […] Medications. Medications are given to reduce heart rate and lower blood pressure, which can prevent the aortic dissection from worsening. They may be given to people with type A aortic dissection to control blood pressure before surgery. […] Treatment of type B aortic dissection may include:

• #96 What is aortic dissection: What you need to know about the causes, types and more – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/heart-and-vascular-articles/2022/january/silent-killer-everything-you-need-to-know-about-aortic-dissection

  After years of treating patients with aortic dissections, I routinely get questions about the signs and symptoms associated with an aortic dissections, how to prevent aortic dissections and what treats are available. […] Type A dissections begin in the ascending aorta (the upper aorta) and require immediate treatment because the complications of an acute aortic dissection are life threatening. […] Because Type B can be equally fatal if not treated quickly, the aortic dissection is treated by expert UChicago Medicine vascular surgeons who repair the damaged blood vessels. […] The best way to prevent an aortic dissection is making sure your blood pressure is well under control. It is important to comply with all medical therapy to maintain a healthy blood pressure long term. This will protect your aorta from complications that could leave to serious consequences.

• #97 Aortic dissection – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_dissection

  Management of AD depends on the part of the aorta involved. Dissections that involve the first part of the aorta (adjacent to the heart) usually require surgery. […] Dissections that involve the second part of the aorta can typically be treated with medications that lower blood pressure and heart rate, unless there are complications which then require surgical correction. […] For Stanford type A (ascending aortic) dissection, surgical management is superior to medical management. For uncomplicated Stanford type B (distal aortic) dissections (including abdominal aortic dissections), medical management is preferred over surgery. […] Complicated Stanford type B aortic dissections require surgical intervention after initiation of medical therapy, with endovascular stent-grafting (TEVAR) available as a less invasive alternative to surgery.

• #98 Aortic dissection – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/445

  Aortic dissection typically presents with abrupt onset chest, back, or abdominal pain that is severe in intensity or is described as 'sharp’ or 'stabbing’, particularly in the patient with a high risk condition (such as Marfan syndrome) or a family history of aortic disease. […] Involvement of the ascending aorta and/or arch (Stanford type A) warrants urgent surgical repair. Dissections of the descending aorta (Stanford type B) are managed medically to control the patients heart rate and blood pressure; surgery in this group is reserved for those with complications such as rupture, visceral or extremity ischaemia, or persistent or recurrent pain. […] Lifelong surveillance is needed with regular imaging to detect complications which may later require surgery.

• #99 Aortic Dissection | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20603

  Management of aortic dissection begins with immediate stabilization and consultation with a cardiothoracic or vascular surgeon, regardless of the location of the dissection. Due to the high mortality associated with untreated AAD, the approach to management involves a combination of urgent surgical intervention and medical therapy to reduce hemodynamic stress on the aorta. […] Once the diagnosis of acute aortic dissection is confirmed or highly suspected, a multidisciplinary team should be activated promptly. Initial management includes: […] Type A dissections are considered surgical emergencies due to the risk of catastrophic complications such as cardiac tamponade, severe aortic regurgitation, myocardial infarction, or aortic rupture. Surgical mortality varies from 5% to 20%. Surgical intervention involves:

• #100 Aortic Dissection: Symptoms, Types, Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/aortic-dissection

  Immediate care is crucial to a good outcome. If you delay treatment until after the aorta ruptures, your chances of survival are less than 50%. For those who get treatment in time, the early mortality rate is still between 9-25%. […] Even with successful surgery, life expectancy after an aortic dissection is shorter than for the general population. You’ll also need ongoing monitoring for the rest of your life, with regular heart scans every few months. […] No. Getting immediate treatment for an aortic dissection is vital.

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