Aortic dissection: Types, causes and treatments

If you or a loved one has “ripping” chest or upper back pain that comes on suddenly, it could be an aortic dissection (aortic tear). You’ll need to get immediate help — ideally at a hospital that treats a high volume of patients with this life-threatening condition.

At the University of Chicago Medicine Center for Aortic Diseases (UCCAD), our cardiac and vascular experts routinely repair the most complex aortic tears using advanced surgical techniques. With our combined heart and blood vessel expertise, we can repair aortic dissections with open heart surgery or minimally invasive options, depending on the type of tear.

Meet Our Aortic Disease Specialists

An aortic dissection is a tear in your aorta, the main artery that transports blood from your heart to other parts of your body. An aortic dissection begins as a tear inside the aortic wall. The tear can continue to worsen, ripping the outer layer of the aorta and allowing blood to escape the artery. The loss of blood flow caused by a leaky aorta means there’s less oxygen for vital organs like your brain, kidneys and heart, which can be deadly.

As many as 40% of people with an aortic dissection die almost instantly, and the risk of death increases by up to 4% every hour the condition is left untreated. However, getting immediate treatment from an experienced team can increase your chances of surviving the condition.

What are the types of aortic dissection?

There are two types of aortic dissection: Type A and Type B.

• Type A aortic dissections begin in the ascending aorta (the upper aorta) and require immediate treatment because the complications are life threatening.
• Type B aortic dissections start in the descending aorta (the lower aorta). While typically not as immediately life-threatening as Type A aortic dissections, Type B aortic tears can sometimes lead to rapid blood loss and death without proper treatment.

Learn more about types of aortic dissection

Aortic Dissection Symptoms

An aortic dissection often doesn’t have warning signs. But once an aortic tear begins, you will usually have severe pain that feels like “ripping” in your chest or upper back almost immediately. This pain is the main sign you could have a dissection.

If you have excruciating chest or upper back pain, go to an emergency department immediately for treatment.

Other aortic tear symptoms include:

• Sudden, severe abdominal or stomach pain
• Difficulty breathing or shortness of breath
• Dizziness or fainting
• Low blood pressure
• Rapid, weak pulse
• Heavy sweating or clammy skin
• Limb weakness (typically in the arms and legs, similar to stroke symptoms)
• Difficulty walking
• Loss of vision
• Difficulty speaking
• Confusion

Recognizing an aortic dissection can be difficult because the symptoms can be confused with a heart attack, stroke or pulmonary embolism (a blockage in the lung).

At UChicago Medicine, our doctors have the training and experience to diagnose and treat these serious conditions.

What causes an aortic dissection?

Certain factors can cause or raise your risk for an aortic tear, including:

• Hypertension (high blood pressure) that is not under control
• Aortic aneurysm, a weak or bulging area in the aorta
• Connective tissue diseases, such as Marfan’s syndrome, Ehlers-Danlos syndrome and other collagen vascular disorders
• Polycystic kidney disease (PKD)
• Chest injury or trauma, such as from a car accident
• Strenuous activities, such as heavy weightlifting

Aortic Dissection Diagnosis

When time is of the essence, our aortic disease specialists know how to diagnose aortic dissection. Beyond taking your history and conducting a thorough examination, we use several tools, including:

• Blood pressure readings, which can be a sign of dissection if the readings are different in both arms
• Chest X-rays to view the aorta, heart and lungs
• Computed tomography (CT) and magnetic resonance imaging (MRI) scans, which can help our team determine the size and location of the dissection
• Transesophageal echocardiogram (TEE), which involves inserting a thin tube down your esophagus and using a probe with sound waves to view your aorta
• Magnetic resonance angiogram (MRA), which uses a contrast dye to view blood flow in the aorta

Your team will use the results of your tests to determine the type of aortic dissection you have and the appropriate treatment.

Aortic Dissection Treatment

Treatment for Type A and Type B aortic dissections is different because of where the tears are in your aorta.

Type A aortic dissection treatment:

Emergency open-heart surgery is needed to treat type A dissections. During an open repair procedure, our cardiac surgeons will remove the torn section of aorta and replace it with a fabric, tube-shaped graft.

Type B aortic dissection treatment:

Some type B aortic dissections do not require immediate surgery and can be managed with medications called beta blockers. These drugs help lower blood pressure and slow your heart rate. We may also recommend lifestyle modifications like not smoking, monitoring your blood pressure daily, and avoiding strenuous activities like weightlifting.

When surgery is needed for type B dissections, our vascular surgeons typically perform a minimally invasive endovascular repair. During this procedure, a vascular surgeon will guide a small tube through a catheter to your aorta. Then they will place a stent or graft to reinforce the blood vessel.

For complex dissections, our cardiac and vascular surgeons often work together, combining open heart surgery with endovascular techniques. This approach allows our team to personalize the procedure based on your specific tear.

Can aortic dissection be prevented?

The best way to prevent an aortic dissection is making sure your blood pressure is under control. Taking your prescribed medication, not smoking and maintaining a healthy weight can help manage your blood pressure over the long term. This will protect your aorta from damage that could weaken its walls and lead to a future dissection.