Aortic Dissection

As the largest artery, the aorta carries oxygen-rich blood from the heart to smaller arteries that run throughout the body. The aorta leads upward from the heart, curves into an arch and then goes down through the chest and abdomen to the pelvis.

The aorta’s wall is lined with three layers: inner, middle and outer. An aortic dissection develops when the inner layer tears, allowing blood to flow between it and the middle layer. The force of the flowing blood creates a channel that can burst (rupture) through the outer layer and cause massive internal bleeding.

Aortic dissections require immediate medical attention because many have the potential to rupture. If left untreated, aortic tears can lead to serious complications, including:

• Organ damage such as kidney failure or intestinal problems, due to reduced blood flow
• Stroke
• Aortic heart valve damage (aortic regurgitation)
• Pressure on the heart from blood building up in the lining that surrounds it, a condition called cardiac tamponade
• Death due to internal bleeding

Aortic dissections are rare. When they do occur, they tend to develop more frequently in the thoracic aorta (upper aorta in the chest). The most common cause is chronic high blood pressure that damages and weakens the aorta’s walls over time.

Other causes of aortic dissections include:

• Certain genetic conditions: Connective tissue disorders can weaken the aorta’s walls. These conditions include Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome and Turner syndrome.
• Congenital heart defects: Some people are born with abnormal structures in the heart that increase the risk of dissection. Defects include a bicuspid aortic valve (with two flaps instead of three) or a narrowed section of aorta (coarctation of the aorta).
• Trauma to the chest: Blunt force trauma, like the type that occurs in serious falls or car accidents, can cause an aortic dissection.

Risk factors for aortic dissection

Factors that can increase the risk of an aortic dissection include:

• Hardening of the arteries (atherosclerosis), a condition in which cholesterol, fat and other substances build up inside artery walls
• Aortic aneurysm
• Age (typically 65 and older)
• Smoking
• Cocaine use

Symptoms occur suddenly and are severe at times. They include:

• Sharp, intense chest or upper back pain — can feel like tearing or ripping and can spread elsewhere in the back or to the neck
• Dizziness or fainting
• Shortness of breath
• Rapid, weak pulse
• Leg pain, paralysis or difficulty walking
• Nausea and vomiting
• Symptoms like those of a stroke — difficulty speaking, vision loss, or weakness or paralysis on one side of your body

Some aortic dissections are difficult to diagnose because their signs and symptoms mimic those of other conditions, including heart attacks. At Henry Ford, our vascular specialists are experts at distinguishing symptoms to pinpoint an aortic dissection diagnosis. Learn more about our vascular testing and our process for aortic disease diagnosis.

The Multidisciplinary Aorta Program is one of the few programs in Michigan offering all available options for dissections. Treatments include medications, minimally invasive procedures and open surgery.

Aortic dissections require immediate, emergency medical care. We typically begin treatment with medications to quickly reduce blood pressure and heart rate. Further treatment varies and depends on where the dissection occurs:

Type A dissections

Type A dissections occur in the ascending aorta (section nearest the heart, including the aortic arch). We usually repair or replace the torn area using open surgery.

In some cases, our surgeons can perform a minimally invasive procedure to repair or replace the torn area. We take an endovascular approach, working inside the aorta with a catheter. This thin, flexible tube is inserted through a needle puncture or tiny incision.

Type B dissections

Dissections in the descending aorta (section past the aortic arch that runs through the chest and abdomen) are type B. Treatment recommendations depend on the dissection’s severity. Our options include:

• Continuing medications to lower blood pressure and heart rate
• Performing an endovascular procedure
• Doing open surgery for more serious warning signs, such as blood leaks or reduced blood flow to the organs or legs

Minimally invasive repair for aortic dissection

For aortic dissections that are repairable with endovascular procedures, our surgeons offer:

• Thoracic endovascular aneurysm repair (TEVAR) for type A dissections
• Endovascular aneurysm repair (EVAR) for type B dissections
• Fenestrated endovascular aneurysm repair (FEVAR) for type B dissections

Open surgery for aortic dissection

Our vascular surgeons and cardiac surgeons have advanced training and experience in open surgery to treat aortic dissections. Find out more about open surgeries for aortic disease treatment and vascular surgery available to you at Henry Ford.

After procedures, you’ll see our vascular medicine specialists and cardiologists for follow-up care and ongoing monitoring. We ensure that your blood pressure is under control and adjust your medications as necessary.