Complications
Occurs when an ascending aortic dissection extends proximally with rupture into the pericardial space.[11]
Emergency surgical repair of the aortic dissection is required. The team may wish to prepare the patient's chest for incision while the patient is awake in the event that the patient sustains cardiac arrest during the induction of anesthesia.
Occurs when dissection propagates proximally, leading to loss of commissural support for the valve leaflets. Urgent surgical repair of the dissected aorta with aortic valve repair or replacement is required.
Occurs when the dissection propagates proximally and coronary ostial occlusion occurs.[11] Urgent surgical repair of the aortic dissection with coronary reconstruction and/or coronary bypass grafting is required.
Aneurysms develop in 34% to 38% of patients with chronic type B aortic dissection and in up to 49% of patients with residual chronic aortic dissection in the distal aorta after type A aortic repair.[24]
Complications from distal aortic dissection occur in 20% to 50% of patients. This occurs due to continued pulsatile force (dP/dt) on already-thinned walls of the false channel or new dissection.
A multidrug antihypertensive regimen including beta blockade to maintain systolic pressure less than 120 mmHg may alter the natural history of chronic dissection by diminishing the rate of aneurysmal dilation.[4][73]
Open surgical repair remains the dominant method of managing chronic aneurysmal thoracoabdominal aortic dissections.[24]
Cerebral, renal, visceral, spinal cord, or lower-extremity ischemia occur when the dissection propagates distally and true lumen occlusion occurs.
Emergency surgical or endovascular repair of the dissected aorta with or without additional revascularization of compromised branch vessels is required.[4]
Occurs when the left subclavian artery is covered after endovascular aortic repair in approximately 15% of patients. The Society for Vascular Surgeons Practice Guidelines recommends routine preoperative revascularization of the left subclavian artery for patients who need elective stent-graft repair where achievement of a proximal seal necessitates coverage of the left subclavian artery, and selective revascularization in urgent indications.[74][75] This can result in subclavian steal syndrome.
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