Aortic Dissection (Dissecting Aortic Aneurysm)

Dissecting aortic aneurysm, more accurately known as aortic dissection, is a serious medical condition in which the wall of the aorta is affected. The aorta is a major blood vessel in the body through which oxygenated blood from the heart reaches all parts of the body. The aortic wall consists of three layers that provide structural strength and contain the blood within the vessel.

During aortic dissection, a tear may develop in the inner layer of the aortic wall. Blood enters the wall of the vessel and pushes the layers away from each other. As a result, there is the formation of a second passage termed the false lumen, whereas the original passage is referred to as the true lumen.

The location of the aortic dissection plays a critical role, as it determines the treatment method and complication potential. Physicians often define aortic dissection as either Stanford Type A or Stanford Type B.

• Stanford Type A: Type A dissection involves the ascending aorta and is a life-threatening emergency because it can cause complications such as aortic rupture, cardiac tamponade, acute aortic regurgitation, coronary artery involvement, or reduced blood flow to organs. It is classified as a surgical emergency since it may affect the heart or cause bleeding around the heart.
• Stanford Type B: Type B does not involve the ascending aorta and typically affects the descending aorta. Some Type B aortic dissections can be treated through medications and observation, while others may require endovascular treatment or surgery.

If left untreated, an aortic dissection can cause stroke, reduced blood flow to the kidneys, intestines, or limbs, internal bleeding, or aortic rupture.

Aortic dissection vs. aneurysm is an important distinction because the two conditions affect the aorta in different ways. During an aneurysm, the walls of the aorta weaken, which may cause the affected portion to protrude due to the pressure from the blood flow. Meanwhile, an aortic dissection results when a tear forms in the inner lining of the aorta. This distinction is vital since each condition presents its own risk factors and treatments.

An aneurysm may often lead to an increased risk of developing a dissection or rupture, but a dissection may occur even when an aneurysm has not been detected in the aorta previously. Both conditions require appropriate medical assessment, with monitoring and treatment determined by their type, location, size, and risk. People with a family history of aortic disease may need assessment and, in some cases, aortic imaging based on their individual risk, while people with hypertension should maintain appropriate blood-pressure control.

Aortic dissection or dissecting aortic aneurysm symptoms often develop suddenly and may vary among individuals. Some individuals primarily experience pain, while others may develop symptoms as a result of blood flow to the heart, brain, kidneys, intestines, or limbs being affected.

• Sudden and severe chest pain: Chest pain is one of the most commonly occurring warning symptoms. It is characterised by sharp, tearing, ripping pain or tight pressure on the chest. This pain often appears suddenly and may rapidly worsen.
• Severe pain in the upper back: Intense pain may be noticed between the shoulder blades or along the upper back. In some cases, the pain radiates from the chest to the upper back as the dissection occurs through the aorta.
• Pain in the abdomen: The pain can appear suddenly or become quite severe when the abdominal part of the aorta is affected by the dissection.
• Shortness of breath: Shortness of breath can occur when the dissection affects the heart or causes complications such as acute aortic regurgitation or fluid accumulation around the heart. Breathing may become difficult as a result of interference with normal heart functions.
• Stroke-like symptoms: Reduced blood flow to the brain may cause weakness or numbness, difficulty with speech and movement, and vision disturbances.
• Weak or absent pulse: An aortic dissection can obstruct blood flow to the arms or legs, potentially causing weak or absent pulses, numbness, pain, or a difference in temperature between the affected and unaffected limb.

Since dissecting aortic aneurysm symptoms can mimic a heart attack, stroke, or other similar heart conditions, they cannot be ignored. Early diagnosis can help doctors begin appropriate treatment before serious complications develop.

Aortic dissection is diagnosed based on the symptoms exhibited by the patient, clinical assessment, and imaging tests. Diagnostic imaging plays an integral part in the process, as they assist in the confirmation of the diagnosis and identification of the location and magnitude of the dissection. The findings also help doctors determine whether the dissection has affected nearby organs or blood flow and guide the choice of appropriate treatment. Understanding the difference between aortic dissection vs aneurysm radiology can help clarify how these two conditions appear on imaging and why distinguishing them is important.

Imaging findings can help doctors distinguish an aortic dissection from an aortic aneurysm and assess the extent and severity of the condition. The imaging characteristics are useful in determining the severity, extent, and localisation of the dissection. This is necessary to determine whether the case requires surgical intervention, endovascular therapy, or medical treatment.

Dissecting aortic aneurysm treatment depends upon the type, severity, complications, and general health status of the individual patient. The treatment objectives include relieving pressure from the aortic wall, stopping further dissection of the aorta, and restoring blood flow where necessary.

• Medication: Medications are prescribed immediately after diagnosis to decrease blood pressure and heart rate. Beta-blockers are the most frequently used medicine for decreasing the impact of blood pressure against the aortic wall. Pain relief is also used because severe pain can increase blood pressure and heart rate, potentially increasing stress on the aortic wall.
• Open Aortic Dissection Surgery: This surgery is often used in cases of type A aortic dissection, which is life-threatening as it affects the ascending aorta. During this surgery, the damaged part of the aorta is replaced by a synthetic graft. Sometimes the aortic valve or aortic root also requires repair or replacement depending upon the location of the dissection.
• Aortic Graft: An aortic graft is a synthetic tube used to replace or reinforce a damaged section of the aorta during surgery. During surgery, the affected portion of the aorta may be replaced with a synthetic graft to restore the continuity of the aorta and reduce the risk associated with the damaged segment.
• Endovascular Stent Graft Placement: EVAR is primarily used for suitable abdominal aortic aneurysms. It is distinct from TEVAR, which is used for selected diseases of the thoracic aorta, including some Type B aortic dissections. A stent-graft is inserted into the artery, usually through the groin. The stent-graft is guided to the site of the aneurysm and placed in the aorta. The graft forms a new route for blood flow to lessen the pressure on the fragile portion of the aorta.
• Thoracic Endovascular Aortic Repair: TEVAR is a minimally invasive technique that is utilised for complicated Type B aortic dissection or some cases of thoracic aortic aneurysms. The stent-graft is guided through an artery to the affected portion of the aorta.

Note: After treatment, patients may require regular follow-up exams and imaging to monitor the aorta. Blood pressure control is also necessary for long-term protection of the aorta.

Treatment costs vary between patients depending on the type and severity of the aortic condition, the treatment approach, hospital charges, length of hospital stay, and any complications. Other factors that might influence the cost include the location of the hospital, the surgeon's fee, ICU charges, grafts/stents, and the complications involved. The figures below are indicative reference costs and should not be interpreted as average private-hospital prices across India. Actual expenses can vary substantially by hospital, city, procedure, graft or stent used, ICU stay, and complications.

Dissecting aortic aneurysm treatment costs in India may vary between healthcare facilities based on the treatment done. Specifically, there may be variation in the cost of emergency aortic dissection surgery, as the procedure is complicated and requires intensive post-operative care.

Aortic dissection treatment may be covered under a health insurance policy if the treatment is medically necessary and falls within the policy's coverage, subject to applicable waiting periods, exclusions, limits, and other terms. Depending on the policy terms, coverage may include

• Hospitalisation: Medical costs for hospitalisation and ICU may be covered under the health insurance policy, subject to the policy’s terms, limits, and exclusions.
• Aortic Surgery: Open surgery for an aortic dissection or aneurysm may be covered when it falls within the policy's covered hospitalisation or surgical benefits and is not excluded, subject to the applicable policy terms.
• Aortic Grafts and Stent Grafts: These could be considered in addition to the aortic surgery. However, some policies have specific restrictions and exceptions for such procedures involving implants and medical devices.
• Diagnostic Tests: Tests like CT angiography, echocardiography, MRI, and blood tests could be covered for medical expenses that may arise during the covered hospitalisation.
• Pre- and Post- Hospitalisation Expenses: The eligible medical costs incurred before and after hospitalisation are covered by some policies.

The level of coverage may be influenced by factors such as co-pay, room rent sub-limit, special sub-limit on particular procedures, and cost of implants, including grafts and stent grafts. It is advisable to check the policy documents and confirm the expected coverage with the insurer or TPA. In an emergency, however, insurance approval should never delay urgent treatment.

In India, health insurance coverage for treatment of aortic aneurysms or aortic dissections is not purely diagnosis-based. Coverage depends primarily on the policy terms, including applicable waiting periods, exclusions, pre-existing disease provisions, and other claim conditions; the insured person's medical history may also be relevant to these provisions.

• Waiting period: Some policies impose a waiting period for pre-existing diseases or particular treatments.
• Insurance policy exclusions: Some treatments, health conditions, and costs might not be covered by the insurance policy.
• Sum insured: The total sum insured under the policy may influence the reimbursement of the cost incurred from aortic surgery treatment due to the complexity of the surgery and the costs involved.
• Co-payment: Under certain insurance policies, the insured is required to pay a certain percentage of the approved medical expenses and the insurer pays the remaining eligible amount.
• Sub-limits: Some policies may place separate sub-limits for certain costs, such as room rents, ICU costs, procedures, and medical devices.
• Graft and stent costs: An aortic operation may involve expensive grafting or stenting procedures. Whether the complete cost is reimbursed or not will depend on the terms of coverage and implant restrictions under the policy.

Thus, a diagnosis of an aortic aneurysm alone does not determine eligibility for insurance cover. The insurance provider may consider the terms of the policy, the patient’s medical background, the type of treatment needed, and claim eligibility. Patients should review these details with their insurer or TPA before planned treatment and keep all relevant medical and hospital documents.

Not all aortic aneurysms or dissections can be avoided, especially in cases of genetic and structural problems. Yet managing the factors that weaken the walls of the aorta can reduce the chances of developing such complications. Some of the most effective steps include:

• Monitor and manage your blood pressure as advised by your doctor.
• Smoking cigarettes harms blood vessels and increases the risk of aortic disease.
• Follow a diet rich in nutritious foods, but avoid excessive salt and unhealthy fats.
• Stay physically active as advised by your doctor. People with an aortic aneurysm or previous aortic dissection may need to avoid strenuous exercise or heavy lifting depending on their individual condition.
• Maintain a healthy weight and follow a balanced diet to support overall cardiovascular health.
• Avoid drinking too much alcohol since heavy alcohol consumption may lead to hypertension and heart-related issues.
• Manage your diabetes and cholesterol by regular testing, proper medication, and lifestyle changes recommended by your doctor.
• Follow the recommended schedule of imaging tests to monitor the aneurysm.

Prevention is mostly aimed at preserving the aorta and managing cardiovascular risk factors. Individuals who have been diagnosed with an aneurysm must follow their doctor's monitoring schedule and seek urgent medical attention for sudden, severe chest, back, or abdominal pain.

Disclaimer: The information provided in this article is for general informational and educational purposes only and should not be construed as medical advice, diagnosis, treatment recommendation, or professional healthcare guidance. Treatment costs mentioned are indicative and may vary based on factors such as the patient's medical condition, hospital, city, surgeon's expertise, room category, and other treatment-related requirements.

Readers are advised to consult qualified healthcare professionals and obtain cost estimates directly from healthcare providers before making any medical or financial decisions. Axis Max Life Insurance does not provide medical services, endorse any specific healthcare provider.