Aortic Dissection

Aortic dissection happens when there is a tear in the inner layer of your aorta — the major artery that carries blood out of your heart. Aortic dissection is a medical emergency because it can lead to a life-threatening aortic rupture.

At UPMC, our cardiothoracic and vascular surgery experts work together to provide fast diagnosis and advanced treatment for aortic dissection.

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• What Is Aortic Dissection?
• What Are the Symptoms of Aortic Dissection?
• How Do You Diagnose Aortic Dissection?
• How Do You Treat Aortic Dissection?

What Is Aortic Dissection?

Arteries have three layers. Aortic dissection is a potentially life-threatening condition in which a tear develops in the inner layer of your aorta, the major artery carrying blood out of your heart.

With an aortic dissection, blood surges through the tear into and along the wall of the aorta, causing the inner and middle layers to separate (dissect). If the blood-filled channel ruptures through the aortic wall, aortic dissection is usually fatal.

How common is aortic dissection?

Aortic dissection occurs in roughly two out of every 10,000 people.

What causes aortic dissection?

Causes of an aortic dissection include:

• Atherosclerosis.
• High blood pressure.
• Degenerative diseases of the aorta.
• Marfan syndrome.
• Bicuspid aortic valve.
• Injury.

What is the main cause of aortic dissection?

Untreated high blood pressure is the most common cause of aortic dissection, followed by atherosclerosis, or plaque buildup in the arteries. Over time, high blood pressure and plaque buildup can weaken the wall of the aorta — especially in people who may have inherited conditions that make them more likely to develop blood vessel disorders.

What are aortic dissection risk factors and complications?

Aortic dissection risk factors

Aortic dissection occurs in approximately two out of every 10,000 people. It can affect anyone but is most common in men aged 40-70.

Most commonly associated with high blood pressure, an aortic dissection also can result from atherosclerosis.

Other risk factors include:

• A major chest injury (such as hitting the steering wheel of a car during an accident).
• A hereditary connective tissue disorder.
• Pregnancy.
• Untreated syphilis.

Aortic dissection is a tear in the inner layer of the aorta. Type A aortic dissection is the most common type of dissection and occurs closer to the heart. It can be life threatening and requires immediate surgical intervention to repair or replace the segment of the aorta where the tear began.

Complications of aortic dissection

An aortic dissection is a medical emergency that requires immediate treatment. If left untreated, aortic dissection can progress to an aortic rupture, which causes severe internal bleeding and is often fatal.

How can I prevent aortic dissection?

You may not be able to control some of your aortic dissection risk factors, such as aging, bicuspid aortic valve, and traumatic injury. However, preventing heart disease and chronic conditions can reduce the risk that you will develop aortic dissection. You may be able to reduce your risk by:

• Eating a diet that is rich in fruits, vegetables, and whole grains.
• Exercising and maintaining a healthy weight.
• Maintaining normal blood pressure and cholesterol levels.
• Avoiding smoking.
• Limiting alcoholic beverages.

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What Are the Signs and Symptoms of Aortic Dissection?

Aortic dissection can occur suddenly, and most cases appear in the emergency department as a sudden catastrophic event.

Are there warning signs before aortic dissection?

You may experience a sharp, tearing pain in your chest or upper back, or feel pain in your:

• Shoulder
• Neck
• Arm
• Jaw
• Abdomen
• Hips

When should I see a doctor about my aortic dissection symptoms?

Aortic dissection is a medical emergency that requires immediate treatment. If you have symptoms of an aortic dissection, dial 911 right away.

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How Do You Diagnose Aortic Dissection?

Since most aortic dissections are diagnosed in the emergency room, your emergency physician will perform a physical exam followed by imaging studies to confirm the diagnosis.

Tests to diagnose aortic dissection

If your doctor suspects you have an aortic dissection, they may order imaging studies including:

• Chest x-ray – A chest x-ray is a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. An x-ray can show enlargement in any area of the heart.
• Echocardiogram (ECHO) –This noninvasive ultrasound test uses sound waves to evaluate your heart's chambers and valves. The ECHO sound waves create an image on a monitor as an ultrasound transducer is passed over your heart.
• Aortography – This minimally invasive test uses a catheter, contrast dye, and x-rays to create images of your aorta.
• CT scans – CT scans create images of your heart.
• MRI scans – MRI is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.

Aortic dissection prognosis

Aortic dissection is a life-threatening condition requiring hospitalization, usually in an intensive care unit (ICU).

The condition can be managed if it is diagnosed and treated before the aorta ruptures.

What is the survival rate for aortic dissection?

Fewer than half of patients with a ruptured aorta survive; however, 60 percent of patients treated for aortic dissection are alive 10 years later.

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How Do You Treat Aortic Dissection?

Aortic dissection treatments often include medication or surgical repair, depending on the severity and location of the dissection. Treatment options may include:

Medicine to treat aortic dissection

If your aortic dissection is located in the descending part of your aorta and is not obstructing any blood vessels, your doctor may treat your condition with medication to lower blood pressure and relieve pain.

Emergent aortic dissection repair

During your emergency aortic dissection repair, your surgeon will remove the largest possible area of the dissected aorta, block the entry of blood into your aortic wall, and replace your aorta with a synthetic graft.

Traditional open-heart repair

Your vascular surgeon will open your chest or abdomen where your aortic dissection is located. Your surgeon will repair your aorta through the incision using a synthetic graft.

Endovascular repair

Your surgeon will repair your aorta using a graft attached to a small tube called a catheter. The catheter is inserted into a small incision in your leg and guided to the damaged area of your aorta.

Aortic valve replacement surgery

If your aortic valve is damaged, your surgeon may replace your aortic valve with a plastic or metal mechanical valve, or a bioprosthetic valve, which is usually made from pig tissue.

Coronary artery bypass graft (CABG) surgery

If your heart arteries are obstructed, blocked, or damaged, your surgeon may perform a CABG procedure to restore blood flow to your heart.

How effective is treatment?

Early treatment for aortic dissection can improve your chances of survival. Sixty percent of patients who are successfully treated for aortic dissection are alive 10 years later.

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By UPMC Editorial Staff. Last reviewed on 2024-10-01.