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February 16th, 2011
03:41 PM ET

Can someone with type B aortic dissection travel?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

Question asked by Satish Desai of Dacula, Georgia:

Can someone with type B aortic dissection travel?

Expert answer:

Aortic dissection is a very serious illness. It is a tear in the aorta, the large blood vessel carrying oxygenated blood from the heart to the rest of the body. The aorta is really hoselike. It comes out of the top of the heart traveling upward a short distance, with the carotid arteries to the brain branching off, and then it curves downward. Smaller blood vessels that supply the arms and the rest of the body with blood stem off the aorta. When the aorta gets to the pelvis, it divides into the two femoral arteries, which supply the legs.

The tear can be incomplete and not through the full thickness of the aorta. It can also be a complete tear, meaning a hole is created, causing internal bleeding. Many patients die immediately from the initial tear and resultant internal bleeding before they even get medical attention.

Those who survive the initial tear typically have sudden onset of severe, sharp or "tearing" chest or back pain. The patient may also have a weak or absent carotid, brachial, or femoral pulse as blood flow to these areas is decreased. The diagnosis of aortic dissection is generally made by an astute physician noninvasively by ultrasound of the chest (echocardiogram), computed tomography scan (CT), or thoracic magnetic resonance imaging (MRI). It can be easily mistaken for a heart attack or even esophageal spasm.

Risk factors for a dissection include older age, a history of cardiovascular or peripheral vascular disease, a history of hypertension, and smoking. People who have an aortic aneurysm or a weakening and out-pouching of the aorta are at especially high risk of dissection. Risk factors for aortic aneurysms include those mentioned for dissection as well as genetic diseases such as Marfan syndrome or connective tissue disorders such as Ehlers-Danlos syndrome.

The Stanford system is the most common of several systems for classifying dissections. Dissections that involve the ascending aorta, the part immediately leaving the heart, are called type A; type B dissections involve the aorta after it is descending.

Acute type A dissection is a surgical emergency. The preferred surgery involves a cardiovascular surgeon opening the chest and placing a synthetic patch over the dissection of the aorta to strengthen it. This surgery is extremely dangerous and is often not successful. Patients who survive the surgery are at high risk for having serious damage to organs that were deprived of oxygen. The kidneys and small bowel are especially vulnerable.

Most type B dissections are actually treated medically unless the patient demonstrates continued bleeding into the chest or the retroperitoneal space (the space behind the abdomen). Medical therapy consists of oral medications to slow the heart rate and reduce blood pressure. A combination of several antihypertensive drugs is usually required. This minimizes stress on the aortic wall. Avoiding strenuous physical activity is also recommended as another method to minimize aortic shear stress. The patient should be regularly screened for evidence of the dissection increasing in size.

Stent grafting is sometimes done as a minimally invasive surgical treatment in selected type A and B dissections that are stable but at high risk for the tear extending or opening to cause internal bleeding. In this procedure, catheters are placed into the femoral artery of the groin and the graft is moved up to the level of the tear and put into place. X-rays are used to identify and assure the appropriate location of the graft. The best candidates for grafts are those who have undergone medical therapy for several months and are stable. Stent grafting is not as effective for type A dissections nor for any acute active life-threatening dissections.

In direct answer to your question about travel, there is nothing about a long airplane ride that would put additional stress on the aorta and increase risk of worsening the dissection, as long as the patient does not do heavy lifting. I actually worry more about deep vein thrombosis (blood clots in the legs) from prolonged sitting.

I still recommend any patient with an illness who is contemplating travel have a good conversation about it with his or her physician. One question to consider is, if you do need complicated surgery while traveling, does the area you are traveling to have the ability to provide that care?


soundoff (46 Responses)
  1. Christine

    Why would one be walking around with an untreated dissection? It can only get worse. You can bet I would be seeing the best doctors at this point.......

    February 16, 2011 at 16:02 | Report abuse | Reply
    • Jim

      Surgery is risky, and depending on the characteristics of the dissection (and the health of the patient), sometimes medical management is preferred.

      February 16, 2011 at 23:45 | Report abuse |
    • Kevin Wall

      Christine, I was just diagnosed with Type B Aorta disection in the lower abdomen. The disection is 3.8 cm length. I have already been taking Lipitor, 40gm ,Losartan 50mg, Metoprolol 100mg. as statins, so Dr.says I am already taking the correct meds.?
      I have an ICD implant so what would be your suggestion on how to conduct future exams to ck. if the 3.8cm disection has grown or not? MRI is out due to the ICD and x-rays are not suggested for numerous checks. Is there a best echo scan method suggested? K.Wall.

      and

      August 21, 2012 at 09:59 | Report abuse |
  2. Christine

    I know the surgery is risky, Jim. I have an ascending aortic aneurysm just above my root. Was diagnosed in June '05. But, it seems to me if there is already a tear what is to stop it from tearing even more? Can the tear heal on its own? What would medical management consist of? I am on Bystolic.

    February 18, 2011 at 18:57 | Report abuse | Reply
  3. Stu

    I had a Type A and B dissection in September 2010. Presented at hospital with chest pains rising up to the jaw and through to the back. After some quick tests, they said I had not had a heart attack. Because they weren't sure, they organized and angiogram for the morning. When asked about family history, I told them my father had a dissection that ruptured while he was in hospital (they saved him and he's still around almost 12 years later!). Anyway, the angiogram was very conclusive and I was prepped for immediate surgery. 6 hours later I was sewn back up with a new dacron graft replacing the first 3 or so inches of my aorta. Blood pressure management is now the key and I'm on four medications to keep it down. CT scan from just last week was very promising. The surgeons were amazing. I was told 90% that have this happen die very quickly. Of those that get to the operating table, 50% survive. This is what killed comedian John Ritter and U.N Diplomat Richard Holbrooke.

    February 18, 2011 at 20:42 | Report abuse | Reply
  4. Christine

    STU....glad to hear that you came out of such a horrifying experience. Funny to me, when they realized you were not having a heart attack, the hospital was going to wait until THE NEXT MORNING to do more tests. I would want all that done ASAP. Time can be of the essence in this. The next morning might be too late for many. So, you had an ascending aortic dissection. John Ritter had his aneurysm in his abdomen as did Lucille Ball and George C. Scott. All died from theirs. Not sure where Richard Holbrookes was. I wonder if he knew he even had an aneurysm? A good many are walking around with them unknowing and that is scary. I hate living with this as every time I have a funny pain in my chest, I stop and think real quick....I am checked every 6 months via echo. Mine has not changed since diagnosis in June of '05. Mine, like most was found in an incidental test at Mayo in Florida. STU: Where was your surgery performed? I do know that they tell you to make sure the doctor that works on you has done this procedure thousands of times....not a few. Glad that you had excellent docs. Many are dead today that did not and that is a shame. Sorry you had to suffer as you did but so glad that you are now on the mend and better. I am only on Bystolic. I hate the way Beta Blockers make me feel and who knows what the long term effect will be??? But, what is our alternative? Best wishes, Stu......Christine in Oregon

    February 20, 2011 at 12:39 | Report abuse | Reply
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