Definitive Treatment

There are definitive treatments for each type of dissection.

Type A

Patients with a Type A dissection require consideration for cardiothoracic surgery.

Urgent surgery is required for Type A dissections because they have the potential to rupture into the pericardium with rapidly fatal consequences. Once a patient with a Type A dissection survives to operation the subsequent in-patient mortality after surgery is 26% [8].

Type B

Patients with a Type B dissection, for whom open surgery is not indicated, must be assessed for the presence of complications of the dissection process. These are:

  • Persistent intractable pain
  • A rapidly expanding aortic diameter
  • Development of a periaortic or mediastinal haematoma
  • Malperfusion of a branch vessel organ
  • Malperfusion due to aortic lumen compression

A meta-analysis of endovascular stent-graft placements for Type B AAD showed that the procedure was successful in 95% of the patients selected for such treatment [3].

Depending upon the aetiology of the branch vessel occlusion either a stent placed in the origin of the vessel, or percutaneous balloon fenestration can be used to alleviate pain or other complications.