Aortic Dissection


Aortic dissection is a rare and potentially fatal condition where there is a tear in the inner layer of the aorta, the large artery that carries blood from the heart to the rest of the body.
When this tear occurs, blood rushes between the layers of the aorta, creating a false lumen.
This can lead to serious complications, such as aortic regurgitation, pericardial effusion, and even aortic aneurysm if not treated promptly.
In fact, according to recent studies, the incidence of aortic dissection is on the rise, particularly among individuals with untreated hypertension. This has highlighted the importance of managing high blood pressure, which may help reduce the risk of life-threatening situations.
Studies show that around 70% of aortic dissection cases may be linked to hypertension.*1
*1 Blood Pressure, Hypertension, and the Risk of Aortic Dissection Incidence and Mortality|AHA Journals
Aortic dissection is classified based on the Stanford classification, which divides the condition into two main types.
Type A dissection – This affects the ascending aorta, which is the portion of the aorta closest to the heart.
Type A dissections are the most dangerous and require urgent surgical intervention to prevent catastrophic outcomes such as aortic rupture or organ failure. In these cases, the tear occurs in the medial layer of the aorta, causing the layers to separate and blood to flow in a way that disrupts blood circulation to vital organs.
Type B dissection – This occurs in the descending aorta, which is the portion that travels downward toward the abdomen. Type B dissections are generally less life-threatening and can sometimes be treated with medical therapy to control blood pressure. However, complications like aortic aneurysm or organ damage may still require surgical treatment.
Fact- Research shows that untreated Type A dissections have a 50% mortality rate within the first 48 hours, underscoring the importance of fast diagnosis and treatment.*2
The symptoms of aortic dissection can often be mistaken for other conditions, making it a challenge to diagnose. However, certain signs should never be ignored
Chest pain – The most common symptom of aortic dissection, often described as a severe, tearing pain, especially in the chest and upper back. Retrosternal pain (pain behind the breastbone) is also common and may radiate to the neck or jaw.
Neurological symptoms – As the dissection progresses, blood flow to the brain may be compromised, causing dizziness, confusion, or even a stroke.
Aortic regurgitation – If the dissection affects the aortic valve, it may lead to a condition called aortic regurgitation, where the heart valve does not close properly, causing blood to leak back into the heart.
Shortness of breath and fluid buildup – In some cases, pericardial effusion (fluid around the heart) may occur, leading to difficulty breathing and other heart-related issues.
Did you know? Many aortic dissections are initially misdiagnosed as heart attacks, delaying treatment.
If you or someone you know experiences these symptoms, it’s critical to seek emergency medical care immediately.
While anyone can experience an aortic dissection, certain factors significantly increase the likelihood of this condition:
Hypertension – High blood pressure is the most common risk factor for aortic dissection, as it increases the stress on the aortic wall, making it more susceptible to tears.
Genetic disorders – Conditions like Marfan syndrome and Ehlers-Danlos syndrome weaken the connective tissue in the body, including the aorta, making individuals with these conditions at a higher risk of dissection.
Age – Most people diagnosed with aortic dissection are between the ages of 40 and 60, although it can occur at any age.
Family history – A family history of aortic dissection or other cardiovascular diseases increases the risk.
Interesting Statistic – Approximately 1 in 10 Australians aged 60+ with poorly controlled hypertension is at risk of developing an aortic dissection. Regular check-ups can drastically reduce this risk.*3
How does hypertension make it worse?
The aortic wall stress created by high blood pressure contributes significantly to the risk of developing an aortic dissection.
Over time, hypertension weakens the medial layer of the aorta, making it more prone to tears. This is why managing high blood pressure is critical, not just for preventing heart attacks and strokes, but for reducing the risk of aortic dissection as well.
How is an aortic dissection diagnosed?
Diagnosing an aortic dissection quickly and accurately is critical.
Doctors use a combination of imaging tests to confirm the condition:
CT scan – Provides detailed, cross-sectional images of the aorta. It is 98%-100% accurate in detecting dissections.*4
MRI – Offers high-resolution images, especially useful for complex cases.
Angiography – Visualises blood flow and blockages using contrast dye.
Accessible Diagnostics – Bulk-billed arterial imaging is available at Gregory Hills, Wollongong, and Orange, making advanced care more affordable for Australian patients.
*4 Recommendations for accurate CT diagnosis of suspected acute aortic syndrome (AAS)|PMC
Treatment for aortic dissection depends on the type and severity of the condition:
For Type A dissection, emergency surgical repair is typically required to fix the tear in the ascending aorta and prevent severe complications, such as stroke, heart failure, or rupture.
For Type B dissection, treatment often involves medical therapy, such as medications to control blood pressure and reduce stress on the aorta. However, if complications arise, surgery may be needed.
Recent studies indicate that early medical intervention, such as controlling hypertension, can significantly reduce the progression of Type B dissections and improve long-term outcomes. Doctors emphasise the need for early detection through imaging and monitoring, especially in high-risk populations.*5
Advances in vascular surgery have made treating aortic dissections safer and more effective.
One game-changing innovation is minimally invasive stent grafting. This approach allows doctors to repair the aorta without major surgery, reducing recovery time and complications.
In 2024, US surgeons performed the first FDA-approved Thoracoabdominal Branch Endoprosthesis (TAMBE) procedure, a groundbreaking device that treats complex aortic dissections with shorter recovery times.*7
Dr Toniolo explains, “The TAMBE device represents a new era in treating life-threatening dissections with minimal invasiveness, giving patients better outcomes.”
He has already assisted in the Wollongong region’s first TAMBE patient procedure and hopes that TAMBE will be offered to more patients in the near future.
*6 Yale Surgeons Perform Connecticut’s First FDA-Approved TAMBE Procedure
Success Rates
– Untreated Type A – 50% mortality in 48 hours.
– Treated Type A – 90% survival post-surgery.
– Endovascular Repair for Type B – Shows up to an 83% success rate within the first year.*8
Early intervention for aortic dissection is critical.
Without treatment, an aortic dissection can lead to devastating complications, including permanent organ damage, stroke, or death.
Regular health check-ups, especially for those over 50 or with high blood pressure, are vital in catching the warning signs early.
Don’t wait until it’s too late. If you or a loved one experience symptoms like tearing chest pain or sudden weakness, seek emergency medical help immediately.
Book a consultation today - Bulk-billed arterial imaging and expert care are available at Gregory Hills, Wollongong, and Orange. Contact AVC to schedule your appointment.
Don’t ignore the signs—take charge of your health today!