Definitive Treatment
There are definitive treatments for each type of dissection.
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].
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.