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Aortic dissection: Difference between revisions

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Aortic dissection (view source)

Revision as of 12:58, 12 October 2024

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<section end="radiology" />
<section end="radiology" />
== Treatment ==
== Treatment ==
Aortic dissection is an emergency and so the patient must be admitted.
Aortic dissection is an emergency and so the patient must be admitted, usually to the ICS.


So-called ''anti-impulse therapy'', involving urgent intravenous antihypertensive treatment to decrease BP and HR (which reduces stress on the aortic wall), is always indicated. This involves [[Beta blocker|beta blockers]] and vasodilators (nitroprusside/nicardipine). The blood pressure should remain < 140/90 for life. Atherosclerotic risk factors should be treated.
So-called ''anti-impulse therapy'', involving urgent intravenous antihypertensive treatment to decrease BP and HR (which reduces stress on the aortic wall), is always indicated. This involves [[Beta blocker|beta blockers]] and vasodilators (nitroprusside/nicardipine). The blood pressure should be decreased to lower-normal ranges.  


Emergency surgery is indicated for Stanford type A dissections, and Stanford type B dissections with complications. Uncomplicated Stanford type B dissections has lower mortality when treated conservatively rather than with surgery.
Emergency surgery is indicated for Stanford type A dissections, and Stanford type B dissections with complications. Uncomplicated Stanford type B dissections has lower mortality when treated conservatively rather than with surgery.
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Surgery involves the replacement of the affected part of the aorta with a prosthesis, or the insertion of a stent graft, or a combination of the two. An affected aortic valve must be replaced.
Surgery involves the replacement of the affected part of the aorta with a prosthesis, or the insertion of a stent graft, or a combination of the two. An affected aortic valve must be replaced.


Possible procedures include Bentall procedure, Frozen elephant trunk, etc.<section end="A&IC" />
Possible procedures include Bentall procedure, Frozen elephant trunk, etc.
<noinclude>‎[[Category:Vascular surgery]]
 
For secondary prevention, atherosclerotic risk factors should be treated, and blood pressure should be kept < 140/90.<section end="A&IC" />
<noinclude>‎
[[Category:Vascular surgery]]
</noinclude>
</noinclude>