The aorta is the main blood vessel that carries blood from the heart to all other parts of the body. An aortic dissection usually starts with a tear in the inner layer of your aorta, allowing blood to seep into the wall. That can compromise blood flow to your organs, or it might lead to life-threatening bleeding.

Aortic dissection is a severe condition that requires immediate medical attention. Learn more about aortic dissection causes, symptoms, and treatments.

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Aortic Dissection Causes

The aorta is a large blood vessel, about one inch in diameter. It’s made up of three layers of tissue.

  • The intima is the innermost layer that comes in contact with your blood.
  • The media is the middle layer of muscle and elastic fibers. It is responsible for the integrity of the aorta and helps the aorta expand and contract as blood flows through.
  • The adventitia is the outermost layer.

An aortic dissection happens when the inner layer tears at a weak spot. That causes blood to leak out into the middle layer. The pressure of the leaking blood splits the wall of the aorta and creates a new channel called the “false lumen,” which compresses the normal “true lumen.”

Aortic dissections aren’t very common. They occur in about two out of every 10,000 people, mostly men aged 40 to 70. Doctors aren’t sure why aortic dissection happens to some people, but these things increase your risk:

  • High blood pressure. This increases the force of blood that pushes against your aorta.
  • A family history of aortic dissection.
  • Aging, because your blood vessels lose elasticity as you age.
  • Genetic conditions like Marfan syndrome or Ehlers-Danlos syndrome. These affect your connective tissue and might compromise the strength of your aortic lining.
  • Certain genetic heart conditions, like a bicuspid aortic valve. With this condition, your aortic valve has only two flaps to prevent blood from flowing back into the heart (there are normally three).
  • Being pregnant, especially if you have other risk factors like connective tissue disorders or high blood pressure.

Aortic Dissection Symptoms

It is unclear how the weak spot develops, but it is more common in the first portion of the aorta (ascending portion) and just beyond the branches to the head and arms. There are usually no symptoms until the lining gives way and tears. The tear, or dissection, happens suddenly and usually causes sudden symptoms like:

  • Sudden severe chest and/or back pain that’s sharp or tearing.
  • Difficulty breathing.
  • Faintness or dizziness.
  • Heavy sweating.
  • Pain in your abdomen or even legs.
  • Trouble swallowing from pressure on your esophagus.

If you have these aortic dissection symptoms, call 911 immediately and get to the emergency room. An aortic dissection is an acute emergency that can be fatal, so it’s essential to get medical care as soon as possible.

Aortic Dissection Treatment

Your health care team can suspect an aortic dissection from your symptoms. They will confirm the diagnosis with imaging tests like a chest x-ray and most importantly, a CT scan, to get a closer look at your aorta. To make sure it is not a heart attack, they will also perform an echocardiogram.

Treatment for aortic dissection depends on the location of the tear and your clinical condition. When the tear is near your heart in the “ascending portion,” it often includes an open surgery in which a surgeon makes a long cut in your chest to work on your aorta. The damaged section of the aorta is replaced with a synthetic fabric tube (graft).

In some cases, especially when the tear is beyond the major branches, you might have a minimally invasive surgery called endovascular repair, which does not require large incisions. A surgeon makes a tiny incision in your groin and threads a catheter to your aorta. The key portion is to deploy a stent graft blocking the tear and redirecting the blood away from the false channel and back into the true lumen.

Controlling the underlying cause of your aortic dissection can limit further damage and help delay surgery. For less severe dissections, your doctor might treat you with medications and monitoring in the intensive care unit.

After going home following a dissection, you will need to:

  • Have regular checkups with your health care provider to look for any changes in your health or aortic dissection.
  • Take medication to keep your blood pressure and heart rate in check to help the aorta heal.
  • Have repeated imaging, usually CT scans, to keep an eye on the dissected aorta and make sure no complications develop.
  • Quit smoking.
  • Take steps to minimize activities that increase blood pressure and heart rate and avoid contact sports.

An aortic dissection is dangerous. In the most severe case, it can cause your aorta to rupture or completely tear and hemorrhage. But if it’s diagnosed early enough, doctors can treat it.

Make sure you talk to your doctor about screening if you have a family history or any risk factors.

Sources

NIH Medline Plus. Aortic Dissection. LINK

About Heart and Vascular Institute

The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine. We strive to provide the most advanced, cutting-edge care for our patients, treating both common and complex conditions. We also offer services that seek to improve the health of our communities, including heart screenings, free clinics, and heart health education. Find an expert near you.