Acute Aortic Emergencies—Part 2 Aortic Dissections

Abstract

Patients with aortic disease are some of the highest acuity patients that emergency clinicians encounter. Dissection is the most common aortic catastrophe and involves separation of the aortic layers in a longitudinal fashion leading to diminished perfusion and systemic ischemia. Characteristics of pain, branch vessel involvement, and incidence lead to an understanding of patient presentation, morbidity, and mortality. Diagnosis, selection of diagnostic studies, the degree of preoperative ischemia, and risk of operative mortality can be accomplished using validated clinical decision tools. Emergency interventions are guided by the type of dissection according to the Stanford classification system. Medical management includes pain control and anti-impulse, antihypertensive therapy through vasodilatation and blockage of the sympathetic β-response. The patient may then be evaluated for open surgical intervention, aortic fenestration, endovascularly placed stent grafts, or a combination possibly in a staged approach. Morbidity includes rupture, stroke, paraplegia, acute renal failure, bowel ischemia, and peripheral ischemia.

Aortic dissection with left supraclavicular pulsatile swelling: a rare presentation

“…1 In most cases this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. 2,3 Also, vomiting, sweating, and lightheadedness may occur. 2 Other symptoms may result from decreased blood supply to other organs such as stroke or mesenteric ischemia.…”

“…2,3 Also, vomiting, sweating, and lightheadedness may occur. 2 Other symptoms may result from decreased blood supply to other organs such as stroke or mesenteric ischemia. 2 Aortic dissection can quickly lead to death from not enough blood flow to the heart or rupture of the aorta.…”

“…2 Other symptoms may result from decreased blood supply to other organs such as stroke or mesenteric ischemia. 2 Aortic dissection can quickly lead to death from not enough blood flow to the heart or rupture of the aorta. 2 Aortic dissection is more common in those with a history of high blood pressure, a number of connective tissue diseases that affect blood vessel wall strength such as Marfan syndrome, a bicuspid aortic valve, and previous heart surgery.…”

“…2 Aortic dissection is more common in those with a history of high blood pressure, a number of connective tissue diseases that affect blood vessel wall strength such as Marfan syndrome, a bicuspid aortic valve, and previous heart surgery. 2,1 Major trauma, smoking, cocaine use, pregnancy, a thoracic aortic aneurysm, inflammation of arteries, and abnormal lipid levels are also associated with an increased risk. 3,2 The diagnosis is suspected based on symptoms with medical imaging such as computed tomography, magnetic resonance imaging, or ultrasound used to confirm and further evaluate the dissection.…”

“…2 Aortic dissection can quickly lead to death from not enough blood flow to the heart or rupture of the aorta. 2 Aortic dissection is more common in those with a history of high blood pressure, a number of connective tissue diseases that affect blood vessel wall strength such as Marfan syndrome, a bicuspid aortic valve, and previous heart surgery. 2,1 Major trauma, smoking, cocaine use, pregnancy, a thoracic aortic aneurysm, inflammation of arteries, and abnormal lipid levels are also associated with an increased risk.…”