Arterial Dissection

Michael N. Tameo, M.D.
Ronald L. Nath, M.D. , F.A.C.S.

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DissectionDissection s when the inner wall of an artery tears and blood flows between 2 layers of the artery wall in 2 lumens (channels) known as the ‘false’ lumen (newly created channel within the wall of the artery), and the ‘true’ lumen (the proper lumen that has always existed). The ‘false’ lumen can often cause collapse and occlusion of the ‘true’ lumen and thus lack of blood flow to the associated organ or limb. Dissection can occur almost anywhere in the body but most commonly occur in the thoracic aorta, abdominal aorta, visceral arteries (splenic, renal, celiac, and hepatic), carotid arteries, and peripheral arteries.

The symptoms from dissection can include severe pain and symptoms associated with ischemia of the affected organ or limb including stroke. Complications from dissection include rupture of the affected artery, which can cause life-threatening bleeding, infarction of the affected organ(s), which can cause organ injury or death, stroke or TIA, and limb-threatening ischemia.

Diagnosis of dissection requires a thorough history and physical exam by a vascular surgeon. An ultrasound and/or computed tomography (CT) scan is usually required.

Treatment of dissection requires medical therapy often combined with a procedure, sometimes emergent, to repair the dissected artery and restore blood flow to the ‘true’ lumen. This may include a minimally invasive (endovascular) treatment with stenting or stent graft placement. If the patient or circumstances do not allow for this technique, then it requires open surgical treatment.