From the Guidelines
Yes, an aortic dissection can occur without an aortic aneurysm. According to the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease 1, aortic dissection is defined as the disruption of the media layer of the aorta with bleeding within and along the wall of the aorta, and it may occur without an aneurysm being present.
Key Points to Consider
- Aortic dissection happens when a tear develops in the inner layer of the aorta, allowing blood to flow between the layers of the aortic wall, forcing them apart.
- While aortic aneurysms can increase the risk of dissection, many dissections occur in aortas of normal size.
- Common risk factors for dissection without aneurysm include:
- Uncontrolled hypertension
- Genetic connective tissue disorders like Marfan syndrome or Ehlers-Danlos syndrome
- Bicuspid aortic valve
- Pregnancy (particularly in the third trimester)
- Cocaine use
- Direct trauma to the chest
- The most common symptom is sudden, severe chest or back pain often described as tearing or ripping.
Importance of Prompt Medical Attention
Prompt medical attention is crucial for any suspected aortic dissection, as it represents a life-threatening emergency requiring immediate diagnosis with CT angiography or other imaging and appropriate management with blood pressure control, pain management, and often surgical intervention depending on the location and severity of the dissection, as noted in the guidelines 1.
From the Research
Aortic Dissection Without Aortic Aneurysm
- Aortic dissection can occur without an aortic aneurysm, as evidenced by a study published in 2024 2.
- This study found that isolated abdominal aortic dissection (IAAD) can occur with or without abdominal aortic aneurysm (AAA), and that the treatment outcomes are similar for both conditions.
- The study reported that 10 out of 18 patients with IAAD had concomitant AAA, while the remaining 8 patients had IAAD without AAA.
Clinical Presentation and Treatment
- The clinical presentation of aortic dissection without aneurysm can be variable, with symptoms ranging from excruciating chest pain to asymptomatic incidental findings 3, 2.
- Treatment options for aortic dissection without aneurysm include conservative management with blood pressure control and antiplatelets, endovascular surgery, and open surgery 2, 4.
- The choice of treatment depends on the location and extent of the dissection, as well as the patient's overall health and medical history.
Association with Other Conditions
- Aortic dissection can be associated with other conditions, such as hypertension, genetic disorders, and inflammatory diseases 5, 6.
- The use of antihypertensive medications, such as beta-blockers and angiotensin-converting enzyme inhibitors, has been shown to improve outcomes in patients with aortic dissection 6.