Background

The aorta is the largest artery in the human body, distributing oxygenated blood from the heart down to the abdomen. From there, branches from the aorta supply blood to the rest of the body.  An aortic dissection occurs when there is a tear in the inner wall of the aorta, causing blood to leak between the layers. This is a sudden event and can present as a medical emergency. Without speedy diagnosis and treatment it can be fatal. Patients who survive are at risk of future chronic complications requiring ongoing treatment and monitoring.

Pauline Latham MP, who is leading the debate in Westminster Hall, has been raising awareness of aortic dissection after she lost her son to the condition at the age of 44, in 2018 (see HC Deb, 9 March 2022, c315). She is a trustee of the Aortic Dissection Charitable Trust (further information can be found on Pauline Latham’s website).

The Aortic Dissection Charitable Trust is a UK and Ireland charity which supports improving diagnosis, increasing survival and reducing disability due to aortic dissection. In particular they are calling for greater consistency of diagnosis, treatment and aftercare, and for funding for medical research into the detection, prevention, treatment and cure for aortic dissection. The Trust’s website provides the following information on the condition:

Aortic dissection is caused by a partial tear in the wall of the aorta. This tear then spreads along the length of the aorta. This can rupture or interrupt the blood supply to vital organs. If the tear occurs in the first part of the aorta, in the front of the chest, it is called a type A dissection. If it occurs in the aorta in the back of the chest it is a type B dissection.

Aortic dissection can affect adults of any age. It is an important cause of maternal death. Untreated type A dissection is almost always fatal. Type B dissection is much less dangerous and is rarely fatal in the short term.

In the UK & Ireland, over 2,000 people per year lose their lives from aortic dissection, by contrast, 1,870 people per year lose their lives in road traffic accidents. Whilst death in pregnancy is very rare 11% of maternal deaths from cardiovascular causes are due to aortic dissection. These numbers are projected to almost double by 2050.

Information on Aortic aneurysm, dissection and rupture is also provided by the British Heart Foundation (BHF – October 2022).

NHS England (PDF) note that the treatment and management of the two main types of aortic dissection, type A and type B, is different:

  • Type A starts in the ascending aorta (the part from the heart to the aortic arch). The risk of rupture is high, and usually requires emergency surgery to repair the aorta by a Cardiothoracic Aortic Surgeon.
  • Type B starts in the descending aorta. The risk of rupture is less than for type A and doesn’t always require immediate surgery. It is initially managed with blood pressure control in a high dependency setting together with close observation for potential complications. These may be managed by Cardiothoracic or Vascular Surgeons or other specialties such as Cardiology depending on the local circumstances.

In addition to pregnancy, other risk factors include lifestyle factors, such as smoking, and risk is further increased by hypertension. There are also certain genetic and connective tissue conditions and autoimmune and Inflammatory conditions associated with higher risk of the condition. Aortic dissection is more common in older people.

Symptoms include sudden onset of severe pain in the chest, back, abdomen or neck, although the pain may quickly settle. A computerised tomography (CT) scan is currently the ‘gold-standard’ diagnostic method.

Management and treatment

NHS England’s Cardiac Pathways Improvement Programme published an Acute Aortic Dissection (AAD) Toolkit (PDF) in March 2022, which set out seven key principles to improve care for emergency acute aortic dissection patients:

  1. Regional governance
  2. Coordination through a Regional Multi-Disciplinary Team (MDT) and a Multi-Disciplinary Meeting (MDM)
  3. Regional rota & Single point of contact
  4. Timely and reliable image transfer
  5. Safe transfer
  6. Specialist treatment for all acute aortic dissections
  7. A regional education programme

The Aortic Dissection Charitable Trust, the Vascular Society, and Aortic Dissection Awareness UK and Ireland are supportive of the toolkit. The Vascular Society note that there is published evidence of variation in the UK in the provision of treatment of conditions of the thoracic aorta. The aim of the toolkit is to help regions to work collaboratively across NHS organisations to ensure they provide equity of access to specialist services and improve outcomes for patients: Acute Aortic Dissection Pathway Toolkit – Vascular Society

The Government has said that all regions of the NHS in England are working with the Cardiac Pathways Improvement Programme to improve diagnosis and treatment to aortic dissection (PQ 901967, Aortic Dissection, 1 November 2022).

Heart Research UK runs aortic surgery masterclasses for surgeons with the aim of improving the care of aortic patients (with a particular focus on aortic dissection): Aortic dissection – Heart Research UK

Research and funding

There is no official data on expenditure on the treatment of aortic dissection or on funding for medical research into the condition. A response to a parliamentary question  (PQ 129120, 1 March 2022) noted that in December 2020, the Department for Health and Social Care convened a multidisciplinary group of experts and patient representatives together to identify high-priority research questions for aortic dissection. In response to an outcome paper from this workshop, the National Institute for Health Research (NIHR) launched a call on ‘Early endovascular repair in type b uncomplicated sub-acute aortic dissection’ and, as of March 2022, was exploring the development of a brief to cover outstanding questions and to “signal the NIHR’s desire to commission research in this important area.” Based on the NIHR’s HTA Funding Committee Public Minutes 18-19 May 2022 it appears that the three proposed research studies submitted under the “Early endovascular repair in type b uncomplicated sub-acute aortic dissection” category were all asked to resubmit their proposals. The NIHR is primarily funded by the Department of Health and Social Care and is the nation’s largest funder of health and care research.

Further reading

Nienaber, C. A. et al. Aortic dissection. Nat. Rev. Dis. Primers 2, 16053 (2016).

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