Aortic dissection begins when an intimal tear allows blood to enter the aortic media, creating a false lumen that can propagate, compromise branch vessels, or rupture. It is one of the most time-critical diagnoses in vascular medicine, and outcomes depend heavily on how quickly the process is recognized and classified.
Classification
Dissections are described by the Stanford system: type A involves the ascending aorta and is generally a surgical emergency, while type B is confined to the descending aorta and is often managed medically in the absence of complications. The distinction drives the entire treatment pathway.
Diagnosis
Presentation classically includes sudden severe chest or back pain, but atypical presentations are common. CT angiography is the primary diagnostic tool, defining the tear location, extent, branch-vessel involvement, and false-lumen status. Transesophageal echocardiography and MR angiography have roles in selected settings.
Management approaches
- Medical therapy. Anti-impulse therapy to control heart rate and blood pressure is the foundation for uncomplicated type B dissection and a bridge to intervention in others.
- Thoracic endovascular aortic repair (TEVAR). A covered stent graft seals the entry tear, promoting false-lumen thrombosis and true-lumen expansion in complicated type B dissection.
- Open surgery. Type A dissection requires urgent surgical repair of the ascending aorta.
- Flow-modulating strategies. Branch-preserving approaches aim to maintain perfusion to vital side branches in complex anatomy.
Modern considerations and surveillance
Contemporary care emphasizes early risk stratification of type B dissection to identify patients who benefit from pre-emptive intervention, and lifelong imaging surveillance for aneurysmal degeneration. Multidisciplinary aortic teams coordinate the medical, endovascular, and surgical decisions that these patients require over time.
INVAMED technologies in this space
INVAMED's aortic portfolio includes the Stena Multilayer Flow Modulator for branch-preserving aneurysm and dissection applications and the ATLAS stent-graft family; see the aortic aneurysm and dissection repair category.
Device availability and approved indications vary by country. This content is prepared for healthcare professionals and does not replace clinical judgment or the instructions for use.