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Aortic dissections are a common and dangerous condition that plague modern society. Even with advancements in modern medicine, guidelines and treatment strategies are ambiguous as to what is the "next best step" when you are trying to manage your condition. There are two types of aortic dissection: Type A and Type B. These types vary based on where in the aorta the blood vessel has split. Type A aortic dissections occur when a rupture is found between ascending aorta and up to the branches that eventually turn into the brachiocephalic artery, the left common cartoid artery and the left subclavian artery. Type B dissections occur when the rupture occurs at any point along the descending aorta. 

Treatment Options for Type A Dissections 

Type A aortic dissections account for more than 50 percent of all types of dissections and are considered a medical emergency. Patients will present with a tearing back pain and a long history of cigarette smoking. If left untreated, 90 percent of patients will die within 30 days of initial insult. When you are found to have a Type A Dissection, your only option to save your life is to undergo cardiovascular surgery to try to fix the rupture in your aorta. For every hour that surgery is delayed, the mortality rate of the patient increases by 1 percent. Due to the lack of perfusion that naturally ensues, patients will often have clinical signs of neurological problems, renal failure and limb ischemia due to lack of circulation. Once stabilized after surgical intervention, patients with type A aortic dissection are given a combination of antihypertensive medication to ensure that their blood pressure is controlled. Beta blockers are imperative to this treatment and studies confirm that 88.6 percent of patients survive longer when given a B-blocker. [1]

Treatment Options for Type B Aortic Dissection 

This is where treatment options can fall into a medical gray zone because surgical intervention is not always the first thing that is considered. In cases where doctors find that there is an uncomplicated aortic tear, medical management is the first line of treatment. Ironically enough, a condition is termed uncomplicated if the patient is still stable with only a small tear. This medical therapy will also be focused on antihypertensive medications but the star of this therapy is a calcium channel blocker that will help patients manage their condition to avoid the tear getting worse. A medical rule of thumb is if the tear is less than 40 millimeters, medical management is preferred. 

Should this dissection progress without adequate blood pressure control, surgical intervention becomes essential. This occurs in 25 percent of cases of patients suffering from a Type B dissection. Elective surgery is recommended in patients with tears up to 60 millimeters. Thoracic endovascular aortic repair (TEVAR) is considered the best option currently available in modern medicine and lowers both morbidity and mortality compared to older techniques. Recent findings have also shown that the sooner this TEVAR therapy is done, the better the survival of patients suffering from a Type B dissection. [2]

Even though aortic dissections are serious medical events, the most important thing to remember is this is not a death sentence. The 5-year survival rate for this condition is 89.4 percent, and a 10-year survival rate is 71.8 percent. Considering patients often present in their 60s or 70s, other comorbidities could be the reason that patients ultimately die. [3]

What Can You Do Now? 

What patients can do to avoid ever getting an aortic dissection is to quit their cigarette smoking. Current smokers are 8 times more likely to have an aortic dissection than nonsmokers. It is also important for patients to routinely get their blood pressure checked to make sure any hypertension is managed to reduce the stress placed on your aorta. Less stress reduces the chance of tears in the blood vessel walls. Lastly, make sure you visit your physician after the age of 60 and get an annual Ultrasound of your abdominal aorta to make sure there are no small tears. 

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