Aortic dissection natural history, complications and prognosis

Aortic dissection Microchapters
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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Natural History

If the patient remains untreated, the mortality is:

• 1% per hour during the first day
• 75% at 2 weeks
• 90% at 1 year

Complications

The complications of aortic dissection include:

• The aorta may rupture, leading to massive blood loss resulting in death. Indeed, aortic dissection accounts for 3-4% of sudden deaths.
• Hypotension and shock due to aortic rupture
• Pericardial tamponade
• Acute aortic regurgitationdue to the aortic dissection generating into Valsalva with an aortic valve insufficiency
• Pulmonary edema
• Myocardial ischemia due to involvement from the right or left coronary ostium (but most commonly the right coronary artery is involved
• Mesenteric and renal ischemia- can lead to hematuria, renal infarction, acute renal failure, or visceral ischemia
• Claudication due to an extension of the dissection into the iliac arteries
• Redissection and aortic diameter enlargement
• Aneurysmal dilatation and saccular aneurysm

Neurologic findings include:

• Ischemic cerebrovascular accident (CVA)
• Hemiplegia
• Hemianesthesia

Compressive symptoms include:

• Superior vena cava syndrome
• Horner syndrome (involves superior cervical ganglia)
• Dysphagia (involves the esophagus)
• Airway compromise
• Hemoptysis (involves the compression of the bronchus)
• Vocal cord paralysis and hoarseness

Prognosis

The mortality rate is in large part determined by the patient's age and comorbidities.

• 30% in hospital mortality
• 60% 10-year survival rate among treated patients

Type A aortic dissection

• Surgical treatment-30% mortality rate
• Medical treatment-60% mortality rate

Type B aortic dissection

• Surgical treatment-10% mortality rate
• Medical treatment- 30% mortality rate