Aortic Dissection

If you have a sudden, ripping pain in your chest or back, or experience a stroke, fainting, or shortness of breath, you might have an aortic dissection.  At Mount Sinai, our experts have the skill and experience to diagnose and treat this rare condition. We offer individualized care that takes into account your overall health and individual situation.

About Aortic Dissection

Aortic dissections occur when the layers of the aorta separate, either due to diseased blood vessel walls or extremely high blood pressure (hypertension).

The artery is your main artery, which carries oxygenated blood from your heart to the rest of your body. There are three parts of the artery wall: the inner, middle, and outer. If the inner part of the artery wall becomes torn, blood flows between the inner and middle layers, which can split apart the three layers.

Symptoms of aortic dissection are similar to other heart problems. In addition to sudden ripping pain, they include:

  • Difficulty walking
  • Leg pain
  • Leg paralysis
  • Loss of consciousness
  • Quick onset of difficulty speaking or seeing
  • Shortness of breath
  • Sudden severe abdominal pain
  • Weak pulse in one arm or thigh compared with the other
  • Weakness or paralysis of one side of your body, similar to those of a stroke

Common risk factors for aortic dissection include:

  • Atherosclerosis
  • Hereditary connective tissue disorder (e.g., Ehlers-Danlos syndrome and Marfan's syndrome)
  • High blood pressure (hypertension)
  • Smoking
  • Nearing the end of a pregnancy
  • Major chest injury, such as from an auto accident
  • Drug addiction (specifically cocaine)

The aorta is a long blood vessel. Dissections in the upper aorta, also called the ascending aorta, are called Stanford A. Dissections in the lower aorta, in the chest and abdomen, are known as descending aortic dissection or Stanford type B dissection. Both conditions require immediate medical attention, though the treatments differ.

Diagnosis and Treatment

We typically diagnose aortic dissection with scanning tests. The most common are:

  • Transesophageal echocardiograms (TEE) use sound waves to produce an image of the heart
  • Computerized tomography (CT) scans use X-rays to develop cross-sectional images
  • Magnetic resonance imaging (MRI) use a magnetic field and radio wave energy to look at blood vessels

We treat aortic dissections with both medication and surgical procedures. We use medication to reduce your heart rate and lower your blood pressure. Depending on your individual situation and overall health, we may prescribe beta blockers, nitroglycerin, or nitroprusside.

If we determine that you need surgery, we can use either minimally invasive, endovascular procedures or open surgical approaches.

The endovascular option uses an aortic stent graft, which we insert through a small tube (catheter) that we move through your blood vessels to the area of the aortic dissection. We insert a stent graft, which opens up the blood vessel so blood can flow freely, repairs the blood leakage, and prevents pressure from rupturing the aorta. After this procedure, you will likely spend a day or two in the hospital.

The traditional approach involves open surgery. We make an incision to your chest and remove the portion of the aorta where the layers have separated. We sew a synthetic tube (graft) in place, which enables your blood to flow normally.

Once you have finished treatment, we will monitor the site regularly to make sure that it does not develop into an aneurysm. You may also need to take blood pressure medication.