The main blood supply pipeline of the human body is the aorta, which bears the highest blood pressure in the body. If the pressure inside the blood vessels is too high, or if there are problems, aging, damage, etc. with the blood vessel wall itself, the aortic blood vessels will rupture like a broken water pipe, causing blood to gush out and endangering life. So, what is aortic dissection? What are the clinical characteristics of aortic dissection? What are the treatments for aortic dissection? Now let me explain aortic dissection to you.
Aortic dissection, also known as aortic dissecting aneurysm, means that after the tear of the aortic intima, the blood in the lumen enters the middle layer of the arterial wall through the intimal tear to form a dissecting hematoma, which extends along the long axis of the artery, forming a serious aortic disease with pathological changes in the true and false lumens of the artery. Active aortic dissection, aortic intramural hematoma (IMH) and transmural atherosclerotic ulcer (PAU) are all characterized by destruction of the middle layer of the artery, and are collectively called acute aortic syndrome (AAS).
Simply put, it's like a tumor bulging on the aorta. Once the blood pressure is too high, it's easy to collapse because this "tumor" is already very fragile. The aorta is very close to the heart, and it is also the thickest artery in the body, so the blood flow pressure is the highest. Once a rupture occurs, the blood that rushes out immediately enters the chest cavity, causing a drop in blood pressure and causing the patient to immediately go into shock. Once aortic dissection ruptures, there is almost no possibility of rescue, so the mortality rate is much higher than that of myocardial infarction. Aortic dissection generally requires surgical treatment to avoid death, especially for type A aortic dissection, which requires the patient's family to not delay time, quickly decide and sign the surgery, in order to save the patient's life in a timely manner. If not treated in a timely manner, the mortality rate within 48 hours can reach up to 50%. The main causes of death are rupture of aortic dissection aneurysm to the chest, abdominal cavity or pericardial cavity, progressive mediastinal and retroperitoneal bleeding, as well as acute heart failure or renal failure.
What are the clinical characteristics of aortic dissection?
62% -78% of patients with aortic dissection have hypertension. Aortic dissection occurs frequently at 6-10 o'clock and 14-16 o'clock, and the incidence rate in winter and spring is significantly higher than that in summer. The most typical symptom of aortic dissection is tear like or knife like pain, which is unbearable. However, the clinical manifestations of aortic dissection have diverse characteristics. For example, when aortic dissection hematoma affects the coronary artery opening, myocardial ischemia or myocardial infarction may occur, manifested as chest pain and arrhythmia (frequent premature ventricular contractions, paroxysmal ventricular tachycardia, etc.); When it affects the root of the aortic valve, severe heart failure or aortic valve regurgitation may occur; When involving the brachiocephalic hepatic artery, severe ischemic attacks or strokes may occur; When it affects the bronchial artery, pulmonary infarction or pulmonary ischemic disease may occur; When it affects the abdominal artery, extensive gastrointestinal ischemia or infarction occurs, and in severe cases, ischemia or necrosis of the spleen, intestine, and superior mesenteric artery may occur.
The treatment of aortic dissection mainly includes drug therapy, interventional therapy, and surgical treatment.
Drug therapy
All patients in the acute phase, regardless of whether they receive intervention or surgical treatment, should first undergo internal medicine drug therapy to avoid further extension and expansion of the interlayer and reduce the incidence of false lumen rupture. Mainly including: absolute bed rest, pain relief treatment, reasonable control of blood pressure and heart rate. Research has shown that patients who control their systolic blood pressure below 120mmHg and maintain a heart rate of 50-60 beats per minute within 6 hours have a significantly higher short-term survival rate compared to those whose blood pressure and heart rate do not meet the standards.
Interventional therapy (endovascular treatment with covered stents)
Stanford classification divides aortic dissection into type A and type B, where type B refers to the rupture occurring in the descending aorta. Covered stent endovascular isolation is considered the preferred surgical method for the treatment of type B aortic dissection. It involves inserting a covered stent into the true lumen and sealing the primary rupture of the dissection, causing the blood flow in the false lumen to be lost, effectively reducing the pressure in the false lumen, and reducing the risk of aortic rupture. Its advantages include minimal trauma, less bleeding, faster recovery, and low mortality rate. It is especially suitable for elderly and those with poor overall health who cannot tolerate traditional surgery.
Surgical treatment
For Stanford type A aortic dissection, surgery is the main treatment method. Surgical treatment aims to remove intimal tears, avoid interlayer rupture causing massive bleeding, and then reconstruct the blood flow status in the area of vascular obstruction caused by intimal flap or false lumen. Surgical treatment needs to be performed under extracorporeal circulation or deep hypothermic circulatory arrest conditions. The surgical trauma is relatively high, and the incidence of complications and mortality is relatively high.
In summary, chest pain is a differential diagnosis of acute coronary syndrome, aortic dissection, acute pulmonary embolism, and other diseases related to coronary heart disease; If unbearable severe chest pain occurs in clinical practice, it is necessary to seek medical attention promptly to avoid accidents!