How is aortic dissection treated

For patients suffering from arterial dissection, they must cooperate with the doctor's treatment in a timely and active manner. Because arterial dissection occurs in the artery and causes significant damage to the main blood vessels of the artery, if it is not treated properly or in time, there is a certain probability that it will lead to the patient's direct death. Therefore, patients with arterial dissection must treat treatment with caution.

Medical treatment

Progress in the treatment of aortic dissection. Currently, there are more and more patients suffering from aortic dissection. With the continuous exploration of treatment, the choice of treatment options is also constantly changing. This article reviews the progress of treatment through the latest research results and related literature at home and abroad, aiming to provide a more reasonable solution for the treatment of aortic dissection. Modern diagnosis and treatment show that the occurrence and development of aortic dissection is related to systolic blood pressure and the rate of change of intra-aortic pressure. The treatment goal is to control the systolic blood pressure at 100-120 mmHg and the ventricular rate at 60-80 beats/min. The KodamaK study found that controlling the heart rate to <60 beats/min can significantly reduce the occurrence of serious complications. If atherosclerosis is present, drugs to stabilize atherosclerotic plaques should be used.

Surgical treatment

Surgical open surgery for patients with aortic dissection is currently mainly used for Standford type A patients, but the incidence of paraplegia can be as high as 5% to 40%, and its mortality rate is no significantly different from that of medical drug treatment. With the continuous development of artificial blood vessels, Sun Lizhong and others in China used the stent "elephant trunk" technique for the first time to treat Stanford type A aortic dissection. The advantage of this surgical method is that it covers the rupture of the dissection intima, expands the true lumen, shrinks the false lumen, and increases blood supply. Endovascular repair treatment In 1998, Dake et al. first used endovascular repair to treat Standford type B aortic dissection, which has been continuously developed and improved since then. Judging from the treatment results in the past decade, endovascular treatment of Standford type B aortic dissection is safe, effective and less invasive.

The most commonly used indicators for endovascular repair treatment are the repair indicators proposed by Nienaber: (1) the distance between the proximal rupture and the opening of the left subclavian artery is >10-15 mm; (2) the false lumen continues to expand; (3) a dissecting aneurysm is formed with a diameter >55 cm; (4) the intimal rupture persists; (5) the pain cannot be relieved; (6) the superior mesenteric artery and at least one renal artery are supplied by the true lumen; and (7) at least one iliofemoral artery is free of dissection.

Timing of endovascular repair In the acute phase of dissection, the aortic wall will swell and the intima will be fragile. After endovascular repair, the incidence of intimal tear and aortic rupture will increase. However, early endovascular repair is beneficial to the reconstruction of the true and false lumens of the dissection. Therefore, Kato et al. [10] suggested that endovascular repair should be performed 4 weeks after onset and before the chronic phase. In the acute phase, endovascular repair should be performed 3 weeks after onset. However, patients with pleural effusion, unrelieved pain, unrelieved ischemia of the aortic branch vessels, and descending aorta diameter >4.5 cm should undergo emergency endovascular repair to avoid dissection rupture and other fatal complications during the waiting period.