An aortic dissection occurs when a tear develops in the inner wall of the aorta, the largest artery in the body.

Blood leaks through the tear, causing the layers of the aortic walls to separate and decrease blood flow to vital organs. If the tear extends through all three of the aortic wall's layers and blood leaks out to the surrounding tissue, that is a rupture.

This is a life-threatening condition and usually requires an emergency intervention or it can result in death.

At the University of Maryland Center for Aortic Disease, we provide rapid, effective treatment for emergency cases via our emergency transport system, University of Maryland ExpressCare and Emergency Department.

Causes of Aortic Dissection

An aortic aneurysm, a bulging in a weak area of the aortic wall, can lead to dissection or rupture. High blood pressure and hardening of the arteries are the most common causes of aortic aneurysms.

Symptoms of an Aortic Dissection

Most people do not have symptoms of an aortic aneurysm. However, when it causes a dissection, symptoms may begin suddenly with severe chest pain that may feel like a heart attack.

Other symptoms include:

  • Sudden, severe or tearing pain in the chest, back, neck, arm, abdomen or between the shoulder blades
  • Clammy skin, nausea and vomiting
  • Dizziness and passing out
  • Rapid heart rate
  • Very low blood pressure

Aortic Dissection Diagnosis

During an exam, your health care provider will take your family history and listen to your heart, lungs and abdomen using a stethoscope. If there is dissection present, the exam may find:

  • A blowing murmur over the area of the tear, a heart murmur or other abnormal sound
  • A difference in blood pressure between the right and left arms, or between arms and legs
  • Low blood pressure
  • Signs resembling a heart attack
  • Signs of shock, but with normal blood pressure.

It is most often detected by using diagnostic tests such as X-ray, aortic angiography, CT scan with contrast,  MRI, venous Doppler ultrasound, or an echocardiogram.

Aortic Dissection Treatment

The aorta starts at the top of the heart and rises up (ascending aorta). It passes over the heart in an arch before a portion travels down through the chest to the lower abdomen (descending aorta).

When the tear or dissection is in ascending aorta, it usually requires surgery.

Dissection that occurs in the descending aorta can often be managed with medicines for the short term but will eventually require surgery. Medications that lower blood pressure may be prescribed and may be given intravenously. Beta blockers are the drug of choice.

Aortic Dissection Surgery

Surgery is required for almost all ascending aortic dissections. Surgery is also performed for complicated descending aortic dissections, such as for patients with:

  • High blood pressure that does not respond to medications
  • Dissections that reduce blood flow to vital organs or limbs
  • Dissections that are about to rupture

The procedure, which is the same surgery for aortic aneurysm, can be done as either an open or minimally invasive surgery, depending on the circumstances.