Arterial Dissection (Tear In The Artery)

An arterial dissection is a ‘tear’ in the wall of the artery and commonly occurs in the inner lining of the arterial wall, which is made of three layers. The most common causes of arterial dissection include:

• Traumatic injury
• High blood pressure
• Previous surgical procedure to that artery
• Weakening of the wall of the artery predisposing to injury from genetic diseases or inflammatory conditions (Marfan’s, Ehler’s Danlos, Loeys Dietz, connective tissue disorders, vasculitis)

Sudden acute arterial dissection of the aorta in the chest (thoracic aorta) can cause a ‘tearing’ back pain or chest pain and can disturb and block the blood flow into vital organs/tissues. If there is blockage of blood flow to an organ/tissue, this may need urgent surgical treatment to prevent permanent dysfunction.

The most common area for arterial dissection is the thoracic aorta, near the heart. If the dissection occurs very close to the heart, specialised emergency heart (cardiothoracic) surgery is usually required to prevent a fatal outcome. In some instances, the arterial dissection does not require surgery and the mainstay of treatment is strict blood pressure and heart rate control to prevent further damage to the artery.

Arterial dissections can also occur in any part of the body, and are often monitored over time to assess if the affected vessel weakens and becomes aneurysmal, which may require surgical treatment.

Arterial dissections that do not cause symptoms initially may not cause any symptoms at all and may be found as an incidental finding through ultrasound or CT scan.

At Yarra Vascular Surgeons, we are experienced in the surgical and medical management of arterial dissection. An acute dissection will often be a time critical emergency requiring inpatient evaluation and discussion with cardiothoracic surgical colleagues. Chronic tears may require treatment if it has become aneurysmal, and generally require complex planning to ensure an effective and durable repair.

After an arterial dissection has been operated, we ensure the intervention remains optimised with regular follow up appointments and surveillance ultrasound or CT scans to monitor the repair. We strive to ensure that any procedure we have performed is durable and remains optimised through regular surveillance both clinically and with scanning. Medical management through risk factor optimisation and effective treatment of blood pressure is also a vital part of our treatment approach to arterial dissection and we regularly involve cardiologists, nephrologists, endocrinologists and cardiothoracic surgeons to participate in your overall care.