Learn About Aortic Dissection

What is the definition of Aortic Dissection?

Aortic dissection is a serious condition in which there is a tear in the wall of the major artery carrying blood out of the heart (aorta). As the tear extends along the wall of the aorta, blood can flow in between the layers of the blood vessel wall (dissection). This can lead to aortic rupture or decreased blood flow (ischemia) to organs.

Aortic dissection
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What are the alternative names for Aortic Dissection?

Aortic aneurysm - dissecting; Chest pain - aortic dissection; Thoracic aortic aneurysm - dissection

What are the causes of Aortic Dissection?

When it leaves the heart, the aorta first moves up through the chest towards the head (the ascending aorta). It then bends or arches, and finally moves down through the chest and abdomen (the descending aorta).

Aortic dissection most often happens because of a tear or damage to the inner wall of the aorta. This very often occurs in the chest (thoracic) part of the artery, but it may also occur in the abdominal aorta.

When a tear occurs, it creates 2 channels:

  • One in which blood continues to travel
  • Another where blood stays still

If the channel with non-traveling blood gets bigger, it can push on other branches of the aorta. This can narrow the other branches and reduce blood flow through them.

An aortic dissection may also cause abnormal widening or ballooning of the aorta (aneurysm).

Aortic aneurysm

The exact cause is unknown, but more common risks include:

  • Aging
  • Atherosclerosis
  • Blunt trauma to the chest, such as hitting the steering wheel of a car during an accident
  • High blood pressure

Other risk factors and conditions linked to aortic dissection include:

  • Bicuspid aortic valve
  • Coarctation (narrowing) of the aorta
  • Connective tissue disorders (such as Marfan syndrome and Ehlers-Danlos syndrome) and rare genetic disorders
  • Heart surgery or procedures
  • Pregnancy
  • Swelling of the blood vessels due to conditions such as arteritis and syphilis

Aortic dissection occurs in about 2 out of every 10,000 people. It can affect anyone, but is most often seen in men ages 40 to 70.

What are the symptoms of Aortic Dissection?

In most cases, the symptoms begin suddenly, and include severe chest pain. The pain may feel like a heart attack.

  • Pain can be described as sharp, stabbing, tearing, or ripping.
  • It is felt below the chest bone, and then moves under the shoulder blades or to the back.
  • Pain can move to the shoulder, neck, arm, jaw, abdomen, or hips.
  • The pain changes position, often moving to the arms and legs as the aortic dissection gets worse.

Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include:

  • Anxiety and a feeling of doom
  • Fainting or dizziness
  • Heavy sweating (clammy skin)
  • Nausea and vomiting
  • Pale skin (pallor)
  • Rapid, weak pulse
  • Shortness of breath and trouble breathing when lying flat (orthopnea)

Other symptoms may include:

  • Pain in the abdomen
  • Stroke symptoms
  • Swallowing difficulties from pressure on the esophagus
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What are the current treatments for Aortic Dissection?

Aortic dissection is a life-threatening condition and needs to be treated right away.

  • Dissections that occur in the part of the aorta that is leaving the heart (ascending) are treated with surgery.
  • Dissections that occur in other parts of the aorta (descending) may be managed with surgery or medicines.

Two techniques may be used for surgery:

  • Standard, open surgery. This requires a surgical incision that is made in the chest or abdomen.
  • Endovascular aortic repair. This surgery is done without any major surgical incisions.

Drugs that lower blood pressure may be prescribed. These drugs may be given through a vein (intravenously). Beta-blockers are the first drugs of choice. Strong pain relievers are very often needed.

If the aortic valve is damaged, valve replacement is needed. If the heart arteries are involved, a coronary bypass is also performed.

Who are the top Aortic Dissection Local Doctors?
Elite
Highly rated in
15
conditions
General Surgery
Thoracic Surgery

CHI St Lukes Health

Baylor Clinic

6770 Bertner Ave 
Houston, TX 77030

Joseph Coselli is a General Surgeon and a Thoracic Surgeon in Houston, Texas. Dr. Coselli has been practicing medicine for over 45 years and is rated as an Elite doctor by MediFind in the treatment of Aortic Dissection. He is also highly rated in 15 other conditions, according to our data. His top areas of expertise are Thoracic Aortic Aneurysm, Aortic Dissection, Abdominal Aortic Aneurysm AAA, and Marfan Syndrome. He is licensed to treat patients in Texas. Dr. Coselli is currently accepting new patients.

Elite
Highly rated in
16
conditions
Thoracic Surgery
General Surgery

Northwell Health

North Shore Lij - Medical PC

130 E 77th St 
New York, NY 10075

Derek Brinster is a Thoracic Surgeon and a General Surgeon in New York, New York. Dr. Brinster has been practicing medicine for over 26 years and is rated as an Elite doctor by MediFind in the treatment of Aortic Dissection. He is also highly rated in 16 other conditions, according to our data. His top areas of expertise are Aortic Dissection, Thoracic Aortic Aneurysm, Cystic Medial Necrosis of Aorta, and Adenosine Deaminase 2 Deficiency. He is licensed to treat patients in New York and Virginia.

 
 
 
 
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Elite
Highly rated in
23
conditions
Thoracic Surgery
General Surgery

NewYork-Presbyterian Healthcare System

Weill Medical College Of Cornell Physicians

525 E 68th St 
New York, NY 10065

Leonard Girardi is a Thoracic Surgeon and a General Surgeon in New York, New York. Dr. Girardi has been practicing medicine for over 33 years and is rated as an Elite doctor by MediFind in the treatment of Aortic Dissection. He is also highly rated in 23 other conditions, according to our data. His top areas of expertise are Thoracic Aortic Aneurysm, Aortic Dissection, Heart Bypass Surgery, and Aortic Regurgitation. He is licensed to treat patients in New York.

What is the outlook (prognosis) for Aortic Dissection?

Aortic dissection is life threatening. The condition can be managed with surgery if it is done before the aorta ruptures. Less than one half of people with a ruptured aorta survive.

Those who survive will need lifelong, aggressive treatment of high blood pressure. They will need to be followed up with CT scans every few months to monitor the aorta.

What are the possible complications of Aortic Dissection?

Aortic dissection may decrease or stop the blood flow to many different parts of the body. This may result in short-term or long-term problems, or damage to the:

  • Brain
  • Heart
  • Intestines or bowels
  • Kidneys
  • Legs
When should I contact a medical professional for Aortic Dissection?

If you have symptoms of an aortic dissection or severe chest pain, call 911 or your local emergency number, or go to the emergency room as quickly as possible.

How do I prevent Aortic Dissection?

Many cases of aortic dissection cannot be prevented.

Things you can do to reduce your risk include:

  • Treating and controlling hardening of the arteries (atherosclerosis)
  • Keeping high blood pressure under control, especially if you are at risk for dissection
  • Taking safety precautions to prevent injuries that can cause dissections
  • If you have been diagnosed with Marfan or Ehlers-Danlos syndrome, making sure you regularly follow-up with your provider
Aortic rupture - chest X-ray
What are the latest Aortic Dissection Clinical Trials?
Guo's Subclavian Artery Reconstruction: The Prospective, Multiple Center Study of WeFlow-Tbranch Stent Graft System(GUEST Study)
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Diagnosis and Prognosis for Aortic Aneurysm aNd Dissection in Anzhen
What are the Latest Advances for Aortic Dissection?
Bentall Operation for Pregnant Women with Marfan's Syndrome.
Stanford Type A Acute Aortic Dissection with Leg Ischemia and Visceral Ischemia.
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Aortic Valve Replacement for Libman-Sacks Endocarditis:Report of a Case.
Who are the sources who wrote this article ?

Published Date: June 16, 2020
Published By: Deepak Sudheendra, MD, RPVI, FSIR, Director of DVT & Complex Venous Disease Program, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania Perelman School of Medicine, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Braverman AC, Schermerhorn M. Diseases of the aorta. In: Zipes DP, Libby P, Bonow RO, Mann, DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 63.

Conrad MF, Cambria RP. Aortic dissection: epidemiology, pathophysiology, clinical presentation, and medical and surgical management. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 81.

Lederle FA. Diseases of the aorta. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 69.