Acute Aortic Dissection Toolkit

Emergency Aortic Dissection Pathway Toolkit

Acute Aortic Dissection Pathway Toolkit

THINK AORTA Poster

About

Acute aortic dissection (aAD) is the most common acute event to affect the aorta, more common even than ruptured aortic aneurysm. It can also affect people aged less than 60 years old due to inherited weakness of the aorta or high blood pressure. Aortic dissection can be brought on by heavy weight lifting, coccaine use or pregnancy.

In some people it is fatal condition due to aortic rupture or organ malperfusion.

• Type A Needs emergency surgery to replace the ascending aorta and in some people aortic arch.
• Type B Emergency surgery needed for rupture or malperfusion. Many people can be initially medically managed and monitored.
• Type Non-A Non-B Managed as for Type B.

For more infomation visit Aortic Dissection Explained (The Aortic Dissection Charitable Trust)

Patient guide: Aortic dissection: Patient guide (Aortic Dissection Awareness UK)

Regional rota and Point of contact

Regional standard operating procedure (SOP) will provide Emergency Departments with a single point of contact for referrals.

The aortic team must respond to acute aortic dissection referrals in a timely manner. The receiving doctor will accept the patients for specialist care unless this is deemed inappropriate due to patient choice not to have surgery, frailty, futility (i.e. patient condition unsalvageable) or comorbidities.

When management remains with a local hospital team this must be under a named cardiology consultant or medical consultant with support available when requested from the aortic team.

Stabilisation and safe transfer

People with acute aortic dissection require critical care support both before and after surgery. Transfer to an aortic centre is ideally provided by an Adult Critical Care Transfer Service (ACCTS).

Coordination of care through regional Multi-Disciplinary Team Meetings (MDTs)

MDTs to be quorate will have representation from cardiac surgery, vascular surgery, radiology, cardiology and/or genetic service and a dedicated coordinator. They will meet at least monthly and all patients with acute aortic dissection will be discussed, as will people with chronic aortic dissection and concern regarding rupture.

Timely and reliable image transfer

Radiology services are asked to implement a standard operating procedure (SOP) for the immediate transfer of CT images to their local aortic centre for any patient diagnosed with an acute aortic dissection.

Specialist treatment of all acute aortic dissections

All acute aortic dissection patients who are surgical candidates require critical care management, and this is best provided in a specialist centre.

This allows regular reassessment and access to intervention if there are signs of clinical or radiological deterioration.

Regional education programme

Regional programmes are developing educational resources  including information for patients and families. 

Resources

AAD Self-Assessment Questionnaire