Thoracic Aortic Disease I: Dissection

Thoracic Aortic Disease I: Dissection

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Overview


Cardiothoracic surgeons tend to manage the thoracic aorta where the disease process includes any part of the aorta proximal to the origin of the left subclavian artery. Distal to the left subclavian artery origin is vascular surgeon territory.


There are three principal disease processes affecting the thoracic aorta that present to vascular surgeons:



  1. Thoracic dissection.
  2. Thoracic trauma.
  3. Thoracic aneurysm:

    • Thoracic.
    • Thoracoabdominal.

Thoracic dissection will be dealt with in this chapter, trauma in Chapter 39 and aneurysmal disease in Chapter 33.


Thoracic Dissection


A tear in the thoracic intimal lining allows blood to track into the aortic wall itself where it may create a false channel, usually between the inner 2/3 of the media and the outer 1/3. The flowing blood in the false channel can:



  • recirculate back through the same defect
  • continue down the aorta (antegrade) for a variable length and then re-enter the lumen through secondary tears in the flap
  • continue down the aorta and rupture out of the aorta resulting in aortic rupture
  • track back up the aorta (retrograde), theoretically ending in the pericardium with subsequent tamponade or coronary ischaemia.

The blood flowing in the usual way through the normal lumen is called the ‘true lumen’. The blood flowing under the flap is the false lumen

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Related posts:

  1. Vascular Investigations: Overview
  2. Raynaud’s and Cold Injury
  3. Peripheral Vascular Injury
  4. Angiography II: Access and Imaging

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Jul 1, 2016 | Posted by in CARDIOLOGY | Comments Off on Thoracic Aortic Disease I: Dissection

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