Aortic dissection

The aorta, the main vessel that carries blood from the heart to the rest of the body, is made up of 3 layers. Aortic dissection is a tear that occurs between the innermost and middle layers of the aorta. Aortic dissection occurs in about 3 per 100,000 patients each year. Both men and women are affected.

Can be harmless, serious, or life-threatening

Sometimes aortic dissection is harmless. However, this is not always the case.

Aortic dissection can reduce blood flow to your kidneys, liver, intestines, and legs. This condition is called hypoperfusion and can cause kidney failure, paralysis, and lack of blood flow to the legs. Aortic dissection can also cause your aorta to rupture, which can lead to life-threatening bleeding.

Symptom

May be absent

You may have no symptoms and learn you have an aortic dissection during testing for other reasons.

Chest or back pain

If you have chest or back pain, see your doctor. If the pain is severe, go to the emergency room immediately. Although most chest and back pain is not caused by aortic dissection, this condition can be very serious and can lead to serious illness or death.

Reason

High blood pressure, cocaine use, smoking, and some genetic connective tissue disorders make dissection more likely.

Diagnosis

See a vascular surgeon

If you or someone in your family has Ehlers-Danlos Syndrome, Marfans Syndrome, or Loews-Deitz Syndrome, see a vascular surgeon to be evaluated for aortic dissection. You will be asked questions about your symptoms and medical history, including questions about family members. The vascular surgeon will also perform a physical examination.

Diagnosis can be made through several different types of imaging tests. These may include echocardiography (echocardiogram or ultrasound), MRI and CT scans. CT scan is considered the gold standard.

Treatment methods

The medical team may include a vascular surgeon, cardiac surgeon, general surgeon, or interventional radiologist. Treatment of aortic dissection depends on the type of dissection.

Type A dissection involves the aorta in the front of the chest, right next to the heart.

  • Urgent treatment is needed because a heart attack may occur. 
  • Typically, treatment is traditional surgery that includes opening the chest and repairing and/or replacing the torn aorta.

Type B dissection occurs in the aorta elsewhere in the chest and abdomen.

  • If you have no symptoms, you may not need treatment. 
  • If the dissection is chronic, it can cause enlargement (aortic aneurysm) of the aorta. Depending on the case, minimally invasive stent placement or open surgery may be required.
  • If you are experiencing lack of blood flow to an organ or limb or bleeding, emergency treatment is needed. Typically, the treatment is endovascular stenting, a minimally invasive procedure to reconnect a torn aorta and repair the incision.

The patient recovered well after aortic dissection treatment. When minimally invasive techniques are used, recovery can be quite quick. Traditional surgery may require a longer recovery time.

Live healthy

To minimize the risk of aortic dissection:

  • Check your blood pressure regularly.  
  • If you have high blood pressure, follow your doctor’s instructions to control it. 
  • Avoid using recreational drugs. 
  • If you don’t smoke, don’t start. 
  • If you smoke, ask your vascular surgeon to help you find a smoking cessation program that is right for you.