Heart & Cardiology/Descending Aortic Dissection
Hello. Thank you so much for making yourself available. My question is this:
My 78 year-old active mother was flown to an out of town hospital last week after she was diagnosed with Aortic Dissection Type B. She is being managed with medication in order to keep her blood pressure under control. There was no surgical intervention. Tests (CT scans, blood work, sonogram) did not show that any of her organs or limbs were involved. However, since this has happened her mobility has been affected in that she cannot walk very far. Both of her legs are weak from her knees to her hips and she can barely walk 20 feet without having to sit down. This has greatly affected her quality of life and activity level. We are wondering if this is some type of claudication as a result of the dissection, if itís something temporary, something permanent, or something entirely unrelated.
Thank you very much for your opinion on this.
Typically Type B aortic dissections will be managed with medical therapy alone and no need for surgical intervention. The reason being that medical therapy has proven as effective as surgical therapy therefore its difficult to justify the risk of surgery and its associated complications unless there are specific indications that make it required such as instability or other symptoms.
Your mothers symptoms may be claudication from compromised blood supply to the lower extremity as a result of the dissection. There are a few ways to investigate this. I would start with review of the CT scan and also upper and lower extremity pressure indexes to get an idea of the perfusing pressure in the lower extremities. If reduced this may indicate the problem is blood flow related. The answer to whether the symptoms are likely to resolve or require intervention will depend on the findings of these tests and the anatomy of the dissection on the CT scan. Given the effect this is happening on her quality of life i would certainly seek an opinion from a qualified cardiac/vascular specialist regarding this. Furthermore you can then discuss treatment approaches.
Hope that was helpful,