Aortic dissection

The aorta is the body’s largest blood vessel. It branches off the heart and delivers oxygenated blood to the body. The aorta wall is three layers thick. When the inner layer tears, blood can move between the middle and inner layer of the artery wall and separate (dissect). Aortic dissections are classified in two ways:

• Type A: The more common dissection occurs as the aorta ascends from the heart. This is the more dangerous type of dissection because it occurs closer to the heart.
• Type B: This type of dissection occurs in the lower part of the aorta as it descends towards the abdomen.

Early detection of aortic dissection is important because a tear that extends through the aorta wall is life-threatening.

When an aortic dissection occurs, you may experience symptoms similar to those of a heart attack:

• Pain: You may experience sudden severe pain in the chest, back, or abdomen. A radiating pain in the chest or upper back is described as a tearing or ripping sensation. The pain can extend to the legs and make walking difficult.
• Difficulty breathing: You may feel short of breath or lose consciousness.
• Paralysis: You may lose vision, the ability to speak, or the ability to use limbs on one or both sides of your body.
• Weak pulse: Because less blood is circulating in your body, you may notice a weakened pulse.

Aortic dissection risk factors

Risk factors for aortic dissection are similar to those of a thoracic aortic aneurysm:

• Family history of aortic aneurysm or dissection
• Genetic conditions that affect connective tissues in your body, such as Marfan syndrome or Ehlers-Danlos syndrome
• Bicuspid aortic valve disease
• High cholesterol, which can lead to plaque formation in the artery (atherosclerosis)
• Coronary artery disease (heart disease)
• High blood pressure
• Traumatic injury such as from a car accident or fall

If your doctor suspects an aortic dissection, they will use sensitive cardiovascular imaging techniques including:

• CT scan
• Magnetic resonance angiogram (MRA)

Penn Medicne’s team of cardiologists, cardiac surgeons, and vascular surgeons work quickly to ensure your safe recovery from an aortic dissection. Surgeons in the Aorta Center will use treatments including:

• Thoracic endovascular aortic repair (TEVAR), using a synthetic reinforced graft (tube) threaded through a catheter to the torn part of the aorta
• Hybrid aorta surgery, which uses a combination of open surgery and catheter-based surgery to repair the dissection
• Aorta surgery, an open-chest procedure to repair the torn part of the aorta, usually by removing the diseased section and replacing it with a graft