When the aorta leaves the heart, it first moves up through the chest toward the head; this section is called the ascending aorta. It then bends (arches) and moves down through the chest and abdomen; this section is called the descending aorta. Acute (sudden) dissection involving the ascending aorta is typically considered a surgical emergency and generally must be treated with an open operation involving removal of the dissected aorta and replacement with an artificial material. Dissection involving only the descending thoracic aorta may be treated with minimally invasive procedures such as stenting (called thoracic endovascular aortic repair, or TEVAR), open surgery, or with drugs to lower blood pressure. The choice of therapy depends on whether the dissection causes problems with flow to the branch vessels that arise from the aorta, or if there is an aneurysm associated with the dissection.
Oftentimes a delayed procedure is needed in patients due to an aneurysm that may develop over time, so strict follow-up is needed after discharge from the hospital. This is also true for patients with ascending aortic dissection that extends into the descending thoracic aorta, because of a similar risk of aneurysm over time.
The cause of aortic dissection usually involves multiple factors. Some common risks include:
- Uncontrolled hypertension (high blood pressure)
- Advanced age
- Bicuspid aortic valve
- Cocaine or methamphetamine use
- Narrowing (coarctation) of the aorta
- Connective tissue disorders, such as Marfan, Loeys-Dietz, or Ehlers-Danlos syndromes, among other rare genetic disorders
- Complications from open heart surgery or endovascular procedures
- Hypertension associated with pregnancy
- Aneurysm associated with conditions such as arteritis and syphilis
UAB Medicine’s vascular specialists provide expert treatment of all types of circulatory conditions using a broad range of services, including medical therapy, minimally invasive endovascular procedures, and open surgical reconstruction. Our specialty-trained surgeons and physicians are leaders in their field and have excellent track records in treating some of the most complex vascular diseases and conditions. That expertise is backed by the latest and most advanced technology, facilities, and treatment options, as well as our dedication to patient-centered care. A wide range of specialists work together through the UAB Advanced Limb Preservation program to prevent the need for amputation, preserve maximum function in the lower limbs in people with peripheral artery disease (PAD), and treat associated medical conditions such as diabetes.
Our vascular experts confer extensively with each patient to determine a specific diagnosis and treatment plan based on medical history, physical exam, and a variety of non-invasive testing that includes ultrasound, Doppler with plethysmography, CT scans, and magnetic resonance angiography (MRA). We also employ three-dimensional overlay fusion technology, in which pre-operative imaging is overlaid with images captured during surgery, providing greater accuracy and improved outcomes. In addition, we maintain an operating room designed specifically for vascular therapies, where we perform “hybrid” procedures that combine both open surgery and minimally invasive endovascular techniques and maximize the benefits of both.
As a major academic medical center, UAB maintains an active research program that also manages clinical trials. Our commitment to innovation and discovery often means that patients have access to advanced new treatments long before they are available to the general public.
UAB is an active participant in research and clinical trials for the diagnosis and treatment of aortic dissection. We encourage you to speak to your physician about research and clinical trial options and browse the link below for more information on clinical trials at clinicaltrials.gov.View Clinical Trials