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What is Aortic Dissection?

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Aortic dissection occurs when there is a partial tear in the aortic wall. This tear then spreads along the length of the aorta. This can rupture or interrupt the blood supply to limbs or vital organs. If the tear occurs in the first part of the aorta, in the front of the chest, it is called a type A dissection. If it occurs in the aorta in the back of the chest it is a type B dissection.

Aortic dissection occurs when there is a partial tear in the aortic wall. This tear then spreads along the length of the aorta. This can rupture or interrupt the blood supply to limbs or vital organs. If the tear occurs in the first part of the aorta, in the front of the chest, it is called a type A dissection. If it occurs in the aorta in the back of the chest it is a type B dissection.

Aortic dissection can affect adults of any age. It is an important cause of maternal death. Untreated type A dissection is almost always fatal. Type B dissection is much less dangerous and is rarely fatal in the short term.

In the UK & Ireland, over 2,000 people per year lose their lives from aortic dissection. Whilst death in pregnancy is very rare 11% of maternal deaths from cardiovascular causes are due to aortic dissection. 

Treatment

Treatment for type A dissection requires emergency open-heart surgery. This will save the lives of over three-quarters of patient. Around 3000 patients per year suffer a type A dissection in the UK & Ireland. Half of these die almost immediately after the onset. Although the number of operations for type A dissection is increasing, still only two-thirds of patients who could be saved undergo an operation. The remainder reach hospital but are not diagnosed.

Diagnosis

These people do not die because the NHS lacks the facilities to treat them. The problem is that people are not diagnosed quickly enough, if at all. Patients with aortic dissection typically suffer sudden severe chest pain. The pain can settle completely and routine tests carried out in the Emergency Department can be normal. To make the diagnosis it is necessary to carry out an emergency CT scan. Too often a diagnosis of aortic dissection is not considered and a CT scan is not ordered.

Long-Term Care

Patients who survive an aortic dissection have a long-term condition that places them at risk of future complications. To minimise the risk of these complications developing and treat them effectively if they occur, patients need to be monitored by specialist medical teams.

Screening Relatives

Many conditions predispose a person to aortic dissection and some of these are inherited. If those relatives at risk are identified, measures can be taken to reduce their risk of developing aortic dissection. Screening relatives for these conditions requires specialised clinical genetics input.

A Relatives Perspective

The current variation of treatment that exists for patients is not acceptable, there is a significant opportunity to create and adopt clear standards of care that brings about health equality and the chance for all patients to survive this treatable condition which can be diagnosed and has a survival rate of over 80% when treated with the appropriate care on time.

This variation of care was experienced within my family over a period of 7 days in 2015. My father an otherwise fit and healthy 69 years old, was rushed to hospital with sudden onset of the classic symptoms of aortic dissection; thunderclap pain in the back, chest and abdomen. After a 12-hour admission Dad was discharged with a diagnosis of gastritis and readmitted with debilitating pain 2 hours later. By the time aortic dissection was diagnosed it was all too late for my father to survive this time critical, treatable condition. My father died within 20 hours of the onset of symptoms, it is a frightening fact that 50% of patients die within 48 hours without treatment. 

7 days later, Dad’s sister, my aunt suffered sudden onset of pain and was rushed to hospital. Aortic dissection was quickly diagnosed, and she was transferred immediately for surgical treatment. All credit to the emergency department as it had not been shared that we had a very recent family history of AD. The team were aware of the condition AD, they had a treatment pathway for the patient and as a result my aunt’s life was saved. 

Surviving aortic dissection should not be down to chance.

Sadly, as a family we are not unique, 2,000 people lose their lives each year, 2,000 families lose a loved one unnecessarily to this detectable killer aortic dissection.

It is the mission of the Aortic Dissection Charitable Trust to prevent these tragic outcomes through education, policy change and research.

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