When an aortic dissection is detected, immediate treatment is needed. The recommended treatment will depend on the type of aortic dissection.
Type A aortic dissections always require emergency surgery since a heart attack is possible, while less invasive treatment may be possible for Type B aortic dissections.
- Aspirin therapy: In some patients, over-the-counter aspirin can thin the blood and reduce the risk for clots that can cause heart attacks or strokes. You should only use daily aspirin therapy if it is recommended by your doctor.
- Blood pressure medicines: Also known as antihypertensives, blood pressure medicines are prescription drugs that help lower high blood pressure. Many types of blood pressure medicines are available. They can reduce blood pressure by:
- Lowering the heart rate
- Reducing blood output
- Removing excess water and sodium from the body
- Relaxing the blood vessels
- Helping blood vessels dilate
- Blood-thinning medicines (anticoagulants): This type of medicine helps prevent blood clots from developing.
- Cholesterol medicines: These medicines help lower cholesterol in your blood by:
- Reducing the liver’s production of cholesterol
- Lowering the amount of cholesterol absorbed from food
- Lowering triglycerides
- Increasing high-density lipoprotein (the “good” cholesterol)
Endovascular aneurysm repair, also known as EVAR, is a minimally invasive treatment for thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA). Unlike open surgery, which is performed through a large incision, EVAR is performed through small incisions near the top of your groin. EVAR can be performed with regional or general anesthesia.
In complex cases where endovascular aortic repair isn’t recommended, your vascular surgeon may opt for an open (or traditional) surgical procedure to repair the damaged portion of the aorta.
During an open aortic repair, you’ll be given general anesthesia to put you to sleep. Your surgeon will then make a long incision in the skin of the chest (for the thoracic aorta) or abdomen (for the abdominal aorta). Clamps will be used to block blood flow from the parts of the aorta above and below the aneurysm or dissection. Once blood flow is blocked, the surgeon will replace the damaged portion of the aorta with a graft made of an artificial material.
The graft, which has fortified walls to support blood flow, is sewn into place using stitches. Once the graft is in place, your surgeon will close the incision in the chest or belly with stitches or staples.
An open procedure for treating aortic aneurysm or dissection typically takes three to four hours. After the procedure, you will be carefully monitored in the intensive care unit for several days before being moved into a regular hospital room. How long it takes to completely recover, both in the hospital and after discharge, will depend on the specifics of your surgery, including whether you required a heart-lung machine during the procedure.
Type B aortic dissections, which affect the descending aorta, can cause damage to other parts of the body related to a lack of blood flow. You may need other surgical procedures to treat problems with the brain, intestines, kidneys or lower extremities.
In some cases, Type B aortic dissections that do not cause symptoms may not require treatment. In that situation, active surveillance is usually recommended.
Small and unruptured aortic dissections that do not cause symptoms may be monitored for changes. At the guidance of your medical provider, you will have an ultrasound or CT scan at regular intervals.
