In recent years, we have met more and more patients with aortic dissection, and they are getting younger. At present, the demographic epidemiological research data for aortic dissection is insufficient, but the disease is developing rapidly, with high early mortality. Some patients die before seeking medical advice, and there are also misdiagnosis, which makes it difficult to obtain the exact true incidence rate. So, what is aortic dissection? What are the clinical manifestations and examination methods? How should it be treated? Below, I will introduce it to everyone.
Aortic dissection (AD) refers to the separation of the true and false lumens of the aortic wall, where blood from the aortic intima tears into the aortic media, causing the media to separate and expand along the long axis of the aorta.
The clinical manifestations of aortic dissection
The first symptom of aortic dissection is a persistent and unbearable "tear like" or "knife like" pain in the chest, back, or abdomen. Often accompanied by brief collapse, coma, blindness, loss of sensation or mobility in the lateral limbs. At the beginning of severe pain, the patient's blood pressure may be normal or high. A small number of patients may not feel obvious pain and may directly experience abnormal manifestations of other systems: fainting; Chest tightness and difficulty breathing; Lower limb numbness or paralysis.
Common examination methods
1. Electrocardiogram: No specific changes. When the lesion affects the coronary artery, acute myocardial ischemia or even acute myocardial infarction may occur, but one-third of patients have normal electrocardiogram results.
2. Chest X-ray examination: The chest X-ray may show an enlarged upper mediastinum or aortic arch shadow, irregular shape of the aorta, and local elevation.
3. Echocardiography: It is valuable for diagnosing ascending aortic dissection and can identify complications such as pericardial hemorrhage, aortic valve insufficiency, and pleural hemorrhage.
4. CT examination: Enhanced CT (CTA) scan can display true and false lumens and their sizes, as well as the location of visceral arteries, and can also understand the thrombus situation in the false lumen.
5. Magnetic resonance imaging (MRI): It is the clearest imaging method for detecting aortic dissection separation. It is considered the "gold standard" for diagnosing this disease.
Treatment methods
1. Internal medicine treatment
Although internal medicine treatment cannot fundamentally solve the threat of dissection to life, medication treatment is an important means of pre - and post-operative management. In clinical practice, pain relief, blood pressure control, and heart rate management are used to prevent aortic rupture and dissection from continuing, while also serving as a long-term treatment for improving chronic aortic dissection after surgery.
2. Surgical treatment
Surgical open surgery is mainly aimed at aortic dissection (Standford A type) involving the ascending aorta. By removing the torn lesion blood vessels in the endometrium and replacing them with artificial blood vessels, the dissection is prevented from rupture and massive bleeding, and the blood flow in the blocked area caused by the intimal flap and false lumen is reconstructed. It is the traditional treatment method for aortic dissection and the main treatment for type A aortic dissection. This type of surgery is also the most difficult type of surgery, requiring the replacement of artificial blood vessels and the anastomosis of multiple vascular interfaces. There is no stapler to replace this anastomosis, and it requires the surgeon's exquisite skills to achieve a leak free effect after anastomosis. It also needs to race against time and reduce the ischemia time of the heart, brain, and spinal cord. It tests not only the doctor's skills, but also their psychological endurance.
3. Endovascular treatment
"Endovascular" refers to surgery performed inside the arterial cavity, without the need for thoracotomy. Only a small incision is made in one side of the groin area, and under X-ray fluoroscopy monitoring, an artificial blood vessel stent is placed through the femoral artery to fix the diseased blood vessel to the inner wall of the aorta. The rupture is completely sealed, and the artificial blood vessel acts as a strong shield, isolating high-speed and high-pressure blood flow and preventing the risk of aneurysm rupture. The residual 'still' blood in the false lumen will gradually clot and eventually organize into scars. It is mostly suitable for aortic dissection (Standford B type) where the rupture is located far from the left subclavian artery or limited to the abdominal aorta or iliac artery. In short, aortic dissection is an extremely serious cardiovascular disease. To better protect cardiovascular health, we need to control blood pressure, eat healthily, quit smoking and limit alcohol consumption, undergo regular physical examinations, and seek professional medical treatment as soon as suspicious symptoms appear.