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Aortic Dissection

Checked: 23-04-2020 by Rob Adams Next Review: 23-04-2021

Overview

Aortic dissection is an emergency that is often fatal when missed so:

Aortic dissection is a sudden vascular event where an intimal tear means blood tracks into the aortic wall separating the intimal and medial layers.

Dissection most commonly occurs with a discrete intimal tear, but can occur without one. An aortic dissection is considered acute if the process is less than 14 days old. (1)

Aortic dissection must be considered in any patient ≥ 40 years presenting with sudden onset ‘tearing’ chest, abdominal or back pain. Transient neurology and vomiting are common.

Patients with known aortic disease, who have had a recent aortic procedure or who have a history of connective tissue disease are at greatest risk.

Symptoms are typically worst at onset and may have eased or resolved by the time a patient is assessed.

Acute Aortic Dissection

IF AORTIC DISSECTION IS SUSPECTED - GIVE ANALGESIA IF REQUIRED. IMMEDIATELY REFER TO LOCAL EMERGENCY DEPARTMENT FOR CT AORTOGRAM TO EXCLUDE OR CONFIRM ACUTE AORTIC SYNDROME.

HYPOTENSION IS A RED FLAG

Any person with new onset pain who has a history of aortopathy (or diagnosed first degree relative), aortic dilatation, bicuspid aortic valve or with past aortic surgery should have an emergency CT aortogram to exclude aortic dissection.

Chronic Aortic Dissection - Referral

Chronic dissection should be referred as follows:

If the dissection involves the ascending aorta or aortic arch (Type A) refer to aortic team at Bristol Heart Institute via eRS.
If the dissection involves the thoracic and/or abdominal aorta (Type B) refer to vascular team at Southmead Hospital via eRS. 

While awaiting the appointment the referrer should:

Address CVD risk factors.
Control hypertension.

Online learning

For further online learning please see the Royal College of Emergency Surgery:

https://www.rcemlearning.co.uk/reference/aortic-dissection/

Resources

Please see the local Vascular Directory of Services

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