Aortic Dissection in Nice
Dr. Ilya Khantalin, Vascular Surgeon in Alpes-Maritimes
Aortic Dissection
Dr. Ilya Khantalin in Nice
Aortic dissection is a serious condition affecting the aorta, the main blood vessel in the human body. It is characterized by a tear in the inner layer of the aortic wall (intima), allowing blood to flow between the layers of the aortic wall. As a result of this tear, two channels form within the aorta: a true lumen and a false lumen. This phenomenon can lead to dramatic consequences and poses a life-threatening emergency in the very short term.
Arterial diseases are now managed using modern techniques validated by the Haute Autorité de Santé (French National Health Authority), with an approach that prioritizes innovation and adherence to recognized surgical protocols.
Vascular diseases are classified as Long-Term Conditions (Affections de Longue Durée, ALD), which allows for 100% coverage by the French Social Security system.
What is Aortic Dissection?
Vascular Surgeon in Saint-Laurent-du-Var
Aortic dissection occurs when the intima, the innermost layer of the aortic wall, tears. This tear creates a false passage where blood flows between the different layers of the aortic wall, causing separation. Dissection can occur in any part of the aorta, but is most often observed in the ascending aorta—the section closest to the heart. It can also occur in the descending thoracic aorta and thoracoabdominal aorta.
Aortic dissection is classified anatomically:
- Type A dissection – involves the ascending aorta as the starting point.
- Type B dissection – involves the descending thoracic aorta.
Treatment and patient management differ depending on the type of dissection but always constitute a medical emergency.
The main causes of aortic dissection are often linked to uncontrolled hypertension, dyslipidemia, smoking, congenital abnormalities such as Marfan syndrome, or physical trauma. It can also be associated with degenerative connective tissue disorders. Although rare, it primarily affects adult men, especially those aged 45 to 70.
Diagnosis and Treatment of Aortic Dissection
Vascular Surgery Specialist in Saint-Laurent-du-Var
Symptoms of Aortic Dissection
Symptoms vary depending on the location and severity of the tear. The most common signs include:
- Sudden and severe chest pain: Often described as tearing or ripping, starting in the chest and radiating to the back.
- Abdominal or back pain: Depending on where the dissection occurs, pain may be felt in the abdomen or back.
- Breathing difficulties: When the ascending aorta is involved, intense pain may affect heart function and cause respiratory distress.
- Neurological disorders (e.g., stroke symptoms): If the dissection involves cerebral branches of the aorta, neurological symptoms such as paralysis or vision problems may occur.
- Weakness, fainting, or discomfort
Due to the seriousness of this condition, rapid intervention is crucial to avoid major complications such as heart failure, stroke, or death.
Causes and Risk Factors for Aortic Dissection
Several factors increase the risk of developing aortic dissection:
- Hypertension: Poorly controlled high blood pressure can weaken the aortic wall, making dissection more likely.
- Dyslipidemia and atherosclerosis: Lipid imbalances, especially elevated LDL and triglycerides, can lead to plaque buildup in the aorta.
- Congenital anomalies: Genetic conditions such as Marfan or Ehlers-Danlos syndrome can weaken the aortic wall.
- Physical trauma: A violent impact, such as a car accident, may result in dissection.
Family history, genetic background, and advanced age are also contributing risk factors.
Diagnosis of Aortic Dissection
Diagnosis is based on clinical signs and additional tests:
- Clinical examination: The physician evaluates symptoms, checks vital signs, and looks for complications (e.g., low blood pressure). A notable blood pressure difference between arms may be observed.
- Imaging tests: To confirm the diagnosis, tests such as contrast-enhanced CT scan (Angio-CT) or transesophageal echocardiography are used. These allow for precise visualization of the tear and its extent.
Treatment of Aortic Dissection
Treatment depends on the location (e.g., Type A or B), severity, and overall patient condition. There are two main approaches:
- Medical treatment (first-line for uncomplicated, well-tolerated Type B dissections without persistent severe pain):
When the dissection is stable and does not severely affect heart function, the goal is tight blood pressure control. Hospitalization in an intensive cardiology or ICU unit is required. Medications such as beta-blockers, ACE inhibitors, or vasodilators are administered to reduce pressure on the aortic wall and prevent progression. - Surgical treatment:
In more severe cases like Type A dissection, where vital functions are at risk, emergency surgery is required, typically via sternotomy and cardiopulmonary bypass in a cardiac surgery center. ICU admission in a cardiovascular surgery unit is necessary. Surgery involves repairing or replacing the affected portion of the aorta.
For Type B dissections, endovascular repair may be an option. This less invasive technique involves inserting an aortic stent graft to keep the aorta open.
Follow-up After Aortic Dissection
Long-term follow-up is essential to prevent recurrence and manage complications. Follow-up is handled by both a cardiologist and a vascular surgeon. It includes:
- Strict blood pressure control: Regular monitoring and medication to prevent pressure overload on the aorta.
- Cardiovascular risk management: Smoking cessation, low-fat diet, lipid-lowering drugs to normalize LDL and triglycerides, and appropriate physical activity.
- Monitoring imaging: Regular imaging tests to ensure the dissection remains stable. This may include Angio-CT of the aorta, transthoracic echocardiography (TTE), Doppler ultrasound of supra-aortic trunks, and Doppler of lower limbs.
- Specialist consultations: Regular follow-up with a vascular surgeon to adjust treatment as needed.
Aortic dissection is a medical and surgical emergency that requires urgent, specialized care. As a vascular surgeon, Dr. Ilya Khantalin, based in Saint-Laurent-du-Var, provides tailored care for this complex condition. If you experience risk factors or warning signs, prompt consultation is crucial for proper diagnosis and treatment.