Aortic Dissection: A Case Study

The specialist Aortic Team at RB&HH work together to treat patients with diseases of the thoracic aorta. Professor Christoph Nienaber, an integral member of the team, takes us through a case study of aortic dissection.

Aortic dissection occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the wall of the aorta, forcing the layers apart. Even with optimal treatment, aortic can quickly lead to death, as a result of decreased blood supply to other organs, heart failure, and sometimes rupture of the aorta – it should be treated as a medical emergency.

Those patients with a history of high blood pressure, a known thoracic aortic aneurysm, or those with some connective tissue diseases that affect blood vessel wall integrity such as Marfan syndrome and Ehlers–Danlos syndrome are at higher risk of suffering aortic dissection.

The majority of patients (96%) that present with aortic dissection experience a severe pain that had a sudden onset. The pain may be described as tearing, stabbing, or sharp in character. Through the use of medical imaging technologies such as CT and MRI scans or echocardiography, our consultants are able to diagnosis aortic dissection to decide the best approach for treatment.

There are two types of aortic dissection:

Proximal Aortic Dissection (Type A)

Type A aortic dissection is the more life threating variant and needs urgent diagnosis and un-delayed surgical treatment.  It affects middle aged and very old patients sometimes at extreme surgical risk. For some of these patients catheter based endovascular repair (without thoracotomy) can be an option that the Brompton aortic Team may consider and offer to selected patients.

Type B Aortic Dissection (Descending aorta)

This aortic condition has become the centre of spotlight for endovascular treatment, both in the acute setting (if necessary because of on-going pain or malperfusion) and in the elective setting, weeks or months after it happened. The idea is to remodel the aorta thereby avoid future problems.

Case Study

A previously healthy 84-year-old gentleman presented to the emergency room with undulating chest and back pain. Until recently he was actively engaging in recreational exercise and moderate weight lifting.

Once a normal electrocardiogram (ECG) was recorded, he was given a contrast-enhanced computed tomography (CT) imaging, revealing type B aortic dissection with a narrow true lumen and compromised perfusion of the left common iliac artery

Based on the individual biological condition without major life-limiting comorbidities, the patient was offered undelayed endovascular stent graft repair in the attempt to both reconstruct the dissected aorta and alleviate peripheral ischemia.

Thoracic endovascular aneurysm repair (TEVAR) was successfully performed and flow was successfully redirected to the true lumen after sealing proximal thoracic entries by use of an off-the-shelf commercial stent graft system extended by an open stent configuration. After completion of TEVAR the patient recovered swiftly to leave hospital within four days.

The Royal Brompton Aortic Team with Professor Christoph Nienaber, a pioneer and highly skilled leader in this field, provides catheter-based aortic repair for dissection, aneurysms, and malformations. Beside non –invasive work up and endovascular treatment, the Aortic Team offers lifelong surveillance to their patients.

The Aortic Programme team at Royal Brompton Hospital are world-leaders in aortic care.  For more information or to make an appointment contact our team on  +44 (0)20 3553 9648 or email privatepatients@rbht.nhs.uk