How do you solve the problem of aortic dissection?

Abstract

Every vascular surgeon can remember stories of patients with aortic dissection having thrombolysis for a presumed myocardial infarction, or a V/Q scan and full anticoagulation for a likely pulmonary embolus. My most memorable story is of an international sports coach who developed tearing intrascapular chest pain during the first week of a grand slam tournament and presented to my hospital’s Emergency Department twice and was sent home twice with a prescription for Gaviscon. He felt so unwell he telephoned his physician in the United States who told him he was having an aortic dissection and to immediately go to another hospital and tell the receptionist that he was having an aortic dissection. He survived to tell his story but, given that type A dissection has a 1–2% mortality per hour within the first 24 hours, it was luck rather than excellent healthcare that saved his life.2 Whilst mortality rates are lower for acute type B dissection, they still reach 10% at 30 days.3 In short, aortic dissection is dangerous, carries a significant fatality rate and deserves a higher profile.