Aortic dissection natural history

Associate Editor-In-Chief:

Natural History
If the patient remains untreated, the mortality is:
 * 1% per hour during the first day
 * 75% at 2 weeks
 * 90% at 1 year

Complications
The complications of aortic dissection include:


 * Hypotension and shock from a possible aortic rupture
 * Pericardial tamponade
 * Acute aortic regurgitationdue to the aortic dissection generating into Valsalva with an aortic valve insufficiency
 * Pulmonary edema
 * Myocardial ischemia due to involvement from the right or left coronary ostium
 * Mesenteric and renal ischemia- can lead to hematuria, renal infarction, acute renal failure, or visceral ischemia
 * Claudication due to an extension of the dissection into the iliac arteries
 * Redissection and aortic diameter enlargement
 * Aneurysmal dilatation and saccular aneurysm

Neurologic findings include:
 * Ischemic cerebrovascular accident (CVA)
 * Hemiplegia
 * Hemianesthesia

Compressive symptoms include:
 * Superior vena cava syndrome
 * Horner syndrome (involves superior cervical ganglia)
 * Dysphagia (involves the esophagus)
 * Airway compromise
 * Hemoptysis (involves the compression of the bronchus)
 * Vocal cord paralysis and hoarseness

Prognosis
The mortality rate is conditional and based upon the patient's clinical condition.
 * 30% hospital-based mortality rates
 * 60% 10-year survival rate when treated

Type A aortic dissection
 * surgical treatment-30% mortality rate
 * medial treatment-60% mortality rate

Type B aortic dissection
 * surgical treatment-10% mortality rate
 * medical treatment- 30% mortality rate

Acknowledgements
The content on this page was first contributed by: David Feller-Kopman, MD and C. Michael Gibson M.S., M.D.