What is an aortic dissection? An FIU-Baptist surgeon explains

Even without a rupture, the false lumen can compress the true lumen or obstruct arteries branching from the aorta. This condition, known as malperfusion, reduces blood flow to organs or limbs and can cause a heart attack, stroke, paralysis or intestinal or limb ischemia. These complications can cause severe disability or death, so every hour matters.

Type B dissection begins farther downstream in the descending aorta. Type B dissection is still a medical emergency, but an uncomplicated Type B dissection is generally treated with aggressive blood pressure and heart-rate control together with close imaging surveillance. Urgent intervention is initiated if complications develop.

What are the warning signs of an aortic dissection, and when should someone seek emergency medical attention?

Unfortunately, an underlying aortic aneurysm can develop without noticeable symptoms, so some people do not know they are at risk until a dissection occurs. When a dissection happens, symptoms usually begin suddenly.

Symptoms may include severe chest, upper-back or abdominal pain, shortness of breath, fainting; or signs of a stroke, such as vision changes, slurred speech, weakness or difficulty walking. Patients often describe the pain as a tearing or ripping sensation.

In someone with an enlarged or weakened aorta, a sudden spike in blood pressure, such as during very heavy lifting or from uncontrolled blood pressure, may contribute to a dissection.

Anyone experiencing these symptoms should call 911 immediately.

Who is most at risk for developing an aortic dissection, are there conditions or family histories that people should be aware of?

The most common risk factor is hypertension, particularly when it is uncontrolled. Other risks include an existing aortic aneurysm, a bicuspid aortic valve or associated aortopathy, aortic coarctation, inherited aortic conditions and a family history of aortic disease. Atherosclerotic cardiovascular disease and stimulant drugs such as cocaine may also increase risk. 

Men are more likely than women to experience an aortic dissection, and the condition is more common among people older than 60. However, we also see younger patients, including people with inherited conditions or those who use recreational stimulants. Aortic dissection can also occur during pregnancy, particularly during the third trimester or early postpartum period in women with underlying aortopathy.  

For people with known aortic disease, exercise recommendations should be individualized. Very heavy lifting or strenuous resistance training can cause sudden increases in blood pressure.

How is an aortic dissection treated?

An aortic dissection is usually the catastrophic complication of an underlying disease affecting the aortic wall rather than an isolated condition. A dissection usually does not occur in isolation. It is often the acute complication of an underlying problem that has weakened or stressed the aortic wall.

The standard treatment for an acute Type A dissection is open cardiac surgery. We open the chest through the breastbone and place the patient on a heart-lung bypass machine. We then replace the involved portion of the aorta with a synthetic graft. The extent of aortic replacement varies depending on the pathology and anatomy.

During parts of the operation, we may temporarily interrupt circulation and cool the patient’s body to protect the brain and other organs. Temperatures may be lowered to approximately 20-28° Celsius, depending on the surgical strategy. In some procedures require temperatures of 20°C or lower, in a technique known as deep hypothermic circulatory arrest. We may also continue supplying blood selectively to the brain.

These are among the most technically challenging procedures in adult cardiac surgery. Outcomes depend on the patient’s condition, the extent of the dissection and the experience of the surgeon, operating team and medical center. Research shows that outcomes are generally better at high-volume centers with specialized aortic teams.

Baptist Health’s Center for Aortic Disease participates in the International Registry of Acute Aortic Dissection, a consortium of 58 referral centers in 13 countries that studies the diagnosis, treatment and outcomes of aortic dissection. Through its academic affiliation with FIU, the center also contributes to research, medical education and public awareness.

Can an aortic dissection be prevented, or are there things people can do to lower their risk?

Not every aortic dissection can be prevented but identifying an enlarged or genetically vulnerable aorta before a dissection occurs can allow doctors to monitor and treat it. At the Center for Aortic Disease at Baptist, we recognize, study and treat the aorta as an independent organ.

The most important step is to work with a health care professional to control high blood pressure. Quitting smoking, managing cholesterol and blood sugar, maintaining a healthy weight and staying appropriately active support overall cardiovascular health. For people with a known aneurysm or aortic disorder, regular imaging and individualized limits on heavy lifting are especially important.

First-degree relatives of patients with inherited thoracic aortic disease may also benefit from screening.

At the Center for Aortic Disease, we assess the aortic health of patients with heart disease. If the aorta is enlarged, patients may enter an aortic surveillance program where we monitor its size, evaluate possible genetic conditions and help control blood pressure, heart rate and other risks.

Once a dissection occurs, the aorta has already suffered a catastrophic injury. Our goal is to identify vulnerable patients before that happens.