From the Guidelines
Aortic dissection has a high mortality rate, with approximately 25-30% of patients dying within the first 24 hours if left untreated, and up to 50% mortality within the first week, as reported in 1.
Mortality Rate and Treatment
The treatment for aortic dissection depends on the type of dissection.
- For Type A (involving the ascending aorta), emergency surgery is the standard treatment to replace the damaged section of aorta with a synthetic graft, as recommended in 1.
- For Type B (affecting only the descending aorta), medical management is often preferred initially, using medications to control blood pressure and heart rate, as stated in 1. These typically include:
- Beta-blockers (such as labetalol, metoprolol, or esmolol)
- Calcium channel blockers
- Vasodilators to maintain systolic blood pressure between 100-120 mmHg Pain management with opioid analgesics is also essential.
Complicated Type B Dissections
For complicated Type B dissections with organ malperfusion or continued pain, endovascular repair with stent grafts may be necessary, as mentioned in 1.
Long-term Management
Long-term management includes:
- Lifelong blood pressure control
- Regular imaging surveillance every 6-12 months
- Modification of risk factors The high mortality rate stems from the risk of aortic rupture, which causes catastrophic internal bleeding, as well as complications like stroke, heart attack, or organ failure due to compromised blood flow, as discussed in 1.
From the Research
Mortality Rate
- The mortality rate for untreated acute aortic dissection is high, with rates ranging from 50% to 65% within the first 48 hours 2.
- Without surgical intervention, the mortality rate exceeds 50% within 48 hours and 80% within 2 weeks, with a 5-year survival rate of 19% 3.
- Most untreated patients with types I and II (proximal) dissection and over half of those with type III (distal) dissection die within 1 year 4.
Treatment
- Open surgery remains the gold standard management for acute type A aortic dissection (ATAAD) 2.
- Endovascular repair offers a useful alternative to medical treatment alone or high-risk open surgical repair in patients who are deemed unfit for surgery 2.
- Appropriate medical treatment and corrective surgery, including total aortic replacement, can be successful in over 90% of cases, with long-term results steadily improving 4.
- Early diagnosis and prompt application of appropriate treatment are key to a successful outcome 4.
Treatment Outcomes
- Despite advancements in surgical technique and critical care, early mortality remains high for acute type A aortic dissection 5.
- Endovascular treatment has comparable early and late outcomes, favorable aortic remodelling, and satisfactory overall survival despite having a higher-risk patient cohort 2.
- The keys to a successful outcome include being aware of the symptoms of dissection, early diagnosis, and prompt application of appropriate treatment, as well as diligent follow-up 4.