Aortic dissection, the tearing of the largest blood vessel in the body, is a rare but life-threatening condition that often comes with little to no warning. Men in their 60s and 70s are at highest risk, but it can happen to anyone of any age, even young people.
Victoria Aucoin, MD, repairs aortic dissections and performs other aortic surgeries in her role as a UNC Health vascular surgeon.
We asked her common questions about this medical emergency. Read on for her answers.
What is an aortic dissection?
The aorta is the biggest blood vessel in the body. It comes out of the heart and supplies blood to the head and neck, then travels down through the chest and sends blood to the abdomen, gut, kidneys and legs. It has three layers. When a dissection happens, the inner layer separates from the outer two layers, creating a false channel for the blood, thus preventing blood flow from getting to vital organs.
Is an aortic dissection always life-threatening?
It depends on where the tear happens. A tear in the ascending part of the aorta, which comes out of the heart and sends blood to the brain, head and neck, is a surgical emergency and life-threatening. Many people experiencing an ascending aortic dissection outside of the hospital setting will die. A tear in the ascending aorta will often prevent blood flow from getting to the heart and/or brain, causing the heart to stop or a massive stroke.
If the dissection is in the descending thoracic aorta, which is in the chest, then it’s still an emergency, because it may prevent blood flow from getting to other organs, like the bowel and kidneys, but it’s often not fatal if care is sought quickly.
What are the symptoms of an aortic dissection?
Symptoms can present suddenly, and they are hard to ignore. People usually complain of excruciating chest pain that radiates to the back between the shoulder blades. Some describe it as a knife stabbing them in the back. Anyone having these symptoms should call 911 and get to an emergency department immediately.
How is an aortic dissection treated?
A tear in the ascending aorta usually requires urgent surgery. Cardiac surgeons open your chest and replace the torn aorta with an artificial tube called a graft; sometimes they replace the aortic valve as well.
If you have a tear in the descending aorta, the torn flap might prevent blood flow to your kidneys, bowel or legs. In that case, we can put a stent graft in the aorta to cover the tear and reestablish blood flow. This can be done through a minimally invasive incision in the groin.
If you have a tear but blood is still flowing where it needs to go, you might not need surgery at all, and with blood pressure medications the tear might heal itself. In all cases, follow-up with your cardiac or vascular surgeon and keeping your blood pressure under control is extremely important.
What are the risk factors for an aortic dissection?
The most common risk factor is high blood pressure. Other risk factors include having an aortic aneurysm, which is an enlargement of the aorta; a bicuspid aortic valve, which is a congenital heart defect in which the aortic valve has two flaps instead of three; and inherited connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome. [More than 200 disorders fall under the umbrella of connective tissue disorders, which affect the connective tissue, such as cartilage and fat, that holds our bodies together.]
When a young person dies suddenly, one of the first things we consider is an aortic dissection caused by one of these genetic disorders.
In addition to high blood pressure, smoking and atherosclerosis, which is plaque buildup in the arteries, are risk factors and common in older patients who have aortic dissections.
Can you prevent an aortic dissection?
The best way to prevent aortic dissection and other cardiovascular emergencies is to take steps to control your blood pressure and monitor your cholesterol levels. That means eating a heart-healthy diet, getting exercise, not smoking and seeing your doctor regularly.
If you have a bicuspid aortic valve or an aneurysm, or a connective tissue disorder, you’ll need regular monitoring with a vascular surgeon or cardiologist. If you have any first-degree relatives, meaning parents or siblings, with these conditions or who had an aortic dissection, you should get screened with an echocardiogram and an abdominal aortic ultrasound.
Can people live normal lives after aortic dissection?
Yes. I see a lot of patients who lead normal, healthy lives with good blood pressure control and medical management, even people who had the dissection 20 years ago. The most important time to be seen is when you first have symptoms. If we intervene early, your chances are good. We treat these often and have an excellent heart and vascular team at the ready.
If you have questions about your heart health, talk to your doctor or find one near you.