From the Guidelines
Aortic dissection after heart catheterization is a rare complication that typically requires conservative management, with complete spontaneous healing observed in most instances, as stated in the 2014 ESC guidelines 1. When aortic dissection is suspected following a heart catheterization procedure, the patient should be immediately stabilized and undergo urgent imaging with CT angiography or transesophageal echocardiography to confirm the diagnosis. The diagnosis of iatrogenic aortic dissection (IAD) is usually straightforward during angiography, characterized by stagnation of contrast medium at the level of the aortic root or ascending aorta, as noted in the 2014 ESC guidelines 1. Initial management includes aggressive blood pressure control and pain management. Definitive treatment depends on the location and extent of the dissection, with dissections extending over several centimeters into the ascending aorta or further propagating requiring emergency cardiac surgery, as recommended in the 2014 ESC guidelines 1. The mechanism of catheter-induced aortic dissection typically involves trauma from the catheter tip or guidewire to the arterial wall, creating an intimal tear that allows blood to enter and split the arterial layers, as discussed in the 2014 ESC guidelines 1. Key points to consider in management include:
- Conservative approach for catheter-induced dissection of the abdominal aorta or iliac arteries
- Emergency coronary stenting for IAD of the right coronary artery ostium
- Careful monitoring for signs of rupture or extension of the dissection
- Aggressive blood pressure control to prevent further propagation of the dissection.
From the Research
Aortic Dissection after Heart Catheterization
- Aortic dissection is a life-threatening condition caused by a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of the layers of the aortic wall 2
- The incidence of aortic dissection is 35 cases per 100,000 people per year, with risk factors including hypertension, dyslipidaemia, and genetic disorders such as Marfan syndrome 2
- Aortic dissection can occur after heart catheterization, although the provided studies do not specifically address this topic
- Treatment of aortic dissection typically involves serial non-invasive imaging, biomarker testing, and genetic risk profiling for aortopathy, with the choice of approach depending on the severity and location of the dissection 2
Risk Factors and Treatment
- Hypertension is a significant risk factor for aortic dissection, and beta-blockers are often used as first-line therapy to decrease aortic wall stress 3, 4
- However, there is limited evidence to support the use of beta-blockers as first-line treatment for chronic type B aortic dissection, with no randomized controlled trials comparing beta-blockers to other antihypertensive medications 3
- Surgical treatment is often necessary for aortic dissection involving the ascending aorta, while minimally invasive endovascular intervention may be appropriate for descending aorta dissections 2, 5
Complications and Management
- Aortic dissection can lead to severe complications, including rupture, malperfusion, and hypotension, and requires swift diagnostic confirmation and adequate treatment 2, 5
- Nursing management includes blood pressure monitoring, serial physical assessment, and postoperative care, as appropriate 5
- Discontinuation of beta-blocker therapy can increase the risk of aortic dissection, as seen in a case report of a 60-year-old male who developed acute aortic dissection after stopping beta-blocker therapy 4