Aortic Dissection vs Aortic Aneursym

I often times get asked this question about what the difference are between the two of these conditions. So, while working on my website today, I came across a pretty simple definition of both:

Aortic dissection refers to tear on the wall of the large vessel coming out of the heart, called the aorta.  This tear causes blood to flow outside the normal area.  Deterioration of the aorta's inner lining is most often seen in patients with hypertension, a congenital disorder, or those who have suffered blunt trauma (such as a car accident).   It is very important to diagnose and treat this condition quickly.   A number of tests are performed to determine the nature of the aorta's pathology, and we are pleased to be able to preserve the non-diseased aortic valves while repairing the diseased areas in most instances.

An aortic aneurysm is an abnormal bulge in the wall of the aorta.  Although an aneurysm can develop anywhere along your aorta, it frequently occurs in the section running through your chest.  Although most aneurysms are small, grow slowly and do not rupture, approximately 15,000 Americans die of a ruptured aortic aneurysm each year.  Most patients learn they have an aortic aneurysm during an exam unrelated to cardiac health.  Depending on the size and location of the aneurysm, it may be best to simply monitor your condition.  If surgical intervention is indicated, the specific procedure will be determined by the cause of the aneurysm and its location.

What if you have an enlarged aorta right now? What do you do about it? I just found a great site, that explains a ton of information.

When is surgery indicated? 

Once a thoracic aneurysm is diagnosed, routine, scheduled follow-up is necessary by an aortic specialist. Aneurysm size needs to be followed closely and surgery is warranted if there is rapid growth over a short period of time or if a critical size is reached. Follow-up typically includes CT scans or MRI's every 6-12 months. 

The ascending aorta grows at a rate of 0.10 cm per year and the descending aorta at a rate of 0.20 cm per year. Should an aneurysm increase in size by 0.4cm in any one year then surgery should be performed.

Decisions regarding surgery can be made if the risk of death, dissection or rupture is known for any particular aneurysm size. This risk can then be compared to the risk of surgery. At St. Luke's-Roosevelt Aneurysm Center the operative mortality of ascending aortic aneurysm surgery is 2.3%. The mortality for aortic arch surgery increases to 5-8% and the mortality for descending thoracic aneurysm surgery is 5.5%. Below is listed the yearly risk of complications based on aortic aneurysm size.

 

			Aortic size
Yearly risk	> 3.5cm	>4.0cm	>5.0 cm	> 6.0cm
Rupture	0.0%	0.3%	1.7%	3.6%
Dissection	2.2%	1.5%	2.5%	3.7%
Death	5.9%	4.6%	4.8%	10.8%
Any of the above	7.2%	5.3%	6.5%	14.1%

 

Given these statistics it is recommended that asymptomatic ascending aortic aneurysms be resected at a size of 5.0-5.5 cm.  If severe aortic insufficiency is present in the setting of a bicuspid valve, the ascending aorta should be resected when it is 4.5 cm in diameter. Descending thoracic and aortic arch aneurysms typically are resected when they exceed 6.0 cm in diameter. A patient with Marfan's syndrome typically warrants earlier intervention.  Symptomatic aneurysms should be resected regardless of size.    

If you need expert help, I have many great surgical references of the top experts in the aortic surgery field. I would be more than happy to help!

Best!

Brian