About Aortic Dissection

The Aorta

The aorta is the major artery in the body. It carries blood from the heart that goes to all organs. The first part of the aorta leaves the heart and goes up in the front of the chest towards the neck. Here it curves backwards to descend in the back.

Aortic Dissection

Aortic dissection occurs when there is a partial tear in the aortic wall. This tear then spreads along the length of the aorta. This can rupture or interrupt the blood supply to vital organs. If the tear occurs in the first part of the aorta, in the front of the chest, it is called a type A dissection. If it occurs in the aorta in the back of the chest it is a type B dissection.

Aortic dissection can affect adults of any age. It is an important cause of maternal death. Untreated type A dissection is almost always fatal. Type B dissection is much less dangerous and is rarely fatal in the short term.

In the UK & Ireland, over 2,000 people per year lose their lives from aortic dissection, by contrast, 1,870 people per year lose their lives in road traffic accidents. Whilst death in pregnancy is very rare 11% of maternal deaths from cardiovascular causes are due to aortic dissection. These numbers are projected to almost double by 2050.

Aorta Diagram
Aortic Dissection types

Treatment

Treatment for type A dissection requires emergency open-heart surgery. This will save the lives of over three-quarters of patient. Over 2800 patients per year suffer a type A dissection in the UK & Ireland (2,300 in England). Half of these die almost immediately after the onset. Although the number of operations for type A dissection is increasing, still only two-thirds of patients who could be saved undergo an operation. This means that over 500 people per year in the UK & Ireland (380 in England), or 10 people per week, could be saved.

Treatment

Treatment for type A dissection requires emergency open-heart surgery. This will save the lives of over three-quarters of patient. Over 2800 patients per year suffer a type A dissection in the UK & Ireland (2,300 in England). Half of these die almost immediately after the onset. Although the number of operations for type A dissection is increasing, still only two-thirds of patients who could be saved undergo an operation. This means that over 500 people per year in the UK & Ireland (380 in England), or 10 people per week, could be saved.

Aortic Dissection types

%

of those suffering from an aortic dissection are misdiagnosed

people per year lose their lives from aortic dissection in the UK

%

of maternal deaths from cardiovascular causes are due to aortic dissection

%

lives could be saved per week with the correct diagnosis

Diagnosis

These people do not die because the NHS lacks the facilities to treat them. Cardiac surgical units across the country have the capacity to carry out the extra operations required. The problem is that people are not diagnosed quickly enough, if at all.

Patients with aortic dissection typically suffer sudden severe chest pain. The pain can settle completely and routine tests carried out in the Emergency Department can be normal. To make the diagnosis it is necessary to carry out an emergency CT scan. Too often a diagnosis of aortic dissection is not considered and a CT scan is not ordered at all.

Emergency Departments see many patients with chest pain and only a few will have an aortic dissection. However, we know that the number of CT scans performed increases greatly in Emergency Departments that ask the question ‘why is this not aortic dissection’ for all patients with chest pain, and as a result, no patients with an aortic dissection have the diagnosis missed.

Long-Term Care

Patients who survive an aortic dissection have a long-term condition that places them at risk of future complications. To minimise the risk of these complications developing and treat them effectively if they occur, patients need to be monitored by specialist medical teams, but the provision of this specialised monitoring for patients is variable.

Screening Relatives

Many conditions predispose a person to aortic dissection and some of these are inherited. If those relatives at risk are identified, measures can be taken to reduce their risk of developing aortic dissection. Whilst some of these genetic conditions are well known and easy to screen for, others are less well known and understood. Screening relatives for these conditions requires specialised clinical genetics input, and relatives’ access to these services is variable.

References

  • Howard DPJ, Banerjee A, Fairhead JF et al. Population-Based Study of Incidence and Outcome of Acute Aortic Dissection and Premorbid Risk Factor Control. 10-Year Results From the Oxford Vascular Study. Circulation. 2013;127:2031-2037
  • Sullivan PR, Wolfson AB, Leckey RD, Burke JL. Diagnosis of acute thoracic aortic dissection in the emergency department. The American Journal of Emergency Medicine 2000;18:46-50.
  • Zhan S, Hong S, Shan-shan L. Misdiagnosis of Aortic Dissection: Experience of 361 Patients. The Journal of Clinical Hypertension 2012;14:256-260
  • Bottle A, Mariscalco G, Shaw MA et al. Unwarranted Variation in the Quality of Care for Patients With Diseases of the Thoracic Aorta. J Am Heart Assoc. 2017;6:e004913
  • Howard DP, Sideso E, Handa A, Rothwell PM. Incidence, risk factors, outcome and projected future burden of acute aortic dissection. Ann Cardiothorac Surg 2014;3:278-284

  • Knight M, Nair M, Tuffnell D, Kenyon S, Shakespeare J, Brocklehurst P, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care – Surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2016.

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The Aortic Dissection Charitable Trust
UK Charity Number 1191420

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