Aortic Dissection

Your risk of having an aortic dissection may be elevated due to a number of reasons, including:

• Age
• History of high blood pressure
• Previous thoracic aortic aneurysm
• Inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome
• Congenital heart defects, such as coarctation of the aorta (narrowing of the aorta)
• Pregnancy
• Blood vessel swelling due to autoimmune conditions, such as arteritis (inflammation of artery walls)
• Syphilis
• Trauma or injury to the aorta, although this is rare

In most cases, aortic dissection occurs when the innermost lining of the aorta becomes torn — and blood from within the aorta flows into the middle layer of the aorta’s lining, forcing the middle and inner layers apart from one another. This results in blood either continuing to flow or staying still. If the blood does not flow, it can pool and push blood on other branches — causing them to narrow and further reduce blood flow. It can also result in a ballooning or widening of the aorta, causing an aneurysm.

An aortic dissection can occur in the chest (thoracic) area of the aorta or the abdominal aorta.

Almost all people with an acute aortic dissection experience pain in the chest, neck, back, abdomen or legs. The area where the pain resides depends on the location of the dissection. The pain often comes on suddenly and is at its most severe at the start. Patients often describe it as a sharp, stabbing pain or tearing. The pain can also travel, moving to the arms or legs as the condition worsens.

Additional symptoms of aortic dissection:

• Anxiety
• Difficulty swallowing
• Dizziness or fainting
• Nausea and vomiting
• Pain in the abdomen
• Pale skin
• Rapid, weak pulse
• Shortness of breath or trouble breathing when lying flat
• Stroke-like symptoms
• Sweating

If you’re suspected to have an aortic dissection, your doctors will conduct a physical examination and review your medical history. In addition, blood work will be done to rule out a heart attack.

Other tests may be required, such as:

• Cardiac MRI
• Chest X-ray,
• Cardiac CT scan with contrast dye
• Echocardiogram or transesophageal echocardiogram (TEE)

In some cases, an aortic dissection can be treated with medications that decrease your blood pressure and manage your pain. Beta blockers may also be prescribed to alleviate hypertension.

Endovascular repair, a minimally invasive treatment option, is sometimes needed to treat aortic dissection. This procedure involves making a very small incision in the leg and using a catheter to place a stent graft to reseal the tear in the lining of your aorta.

If medications or endovascular repair are not possible, open surgery is often necessary. During open surgery, the segment of torn aorta is removed and replaced with a synthetic graft.