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Emergency Surgery Indicated
- Proximal dissection (large dissection
that begins near the heart)
- Or the tear is very extensive
and they continue to have pain even after the blood pressure
has been brought down to a low level
- Surgery would be considered
if the tear in the descending aorta seems to stabilize, but then
grows progressively
- Organ ischemia (kidneys, bowel,
and spinal cord) will also require urgent surgery.
- Evidence of fluid in the pericardial
sac around the heart with a dissection that comes back to the
heart, which suggests that, the tear is going into the pericardial
space.
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Emergency
Surgery Indicated
- Evidence of marked enlargement
of the dissected aorta (aneurysm formation).
- Evidence of blood leakage into
tissue by contrast CT scan or transesophogeal echocardiogram.
- Evidence that blood flow to
one or more vital organs is being compromised.
- Evidence of an intramural hematoma,
a localized collection of blood within the aortic wall that can
accumulate before the dissection progresses along the length
of the aorta. Intramural hematomas indicate an impending dissection,
and should be treated in an identical manner.
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