The aorta is the biggest blood vessel in the body. It carries oxygen-rich blood from the heart to the rest of the body, so it is vital in keeping us alive. An aortic dissection occurs when there is a weakening of the inner layers lining the aorta, causing a leak into the artery wall. This can happen slowly over time, or abruptly, causing a rupture of the wall. This can be very dangerous as it can lead to major blood loss and failure to supply oxygen to the vital organs. It is not common, but it is life-threatening and needs immediate medical care.
It’s often difficult to spot the signs of when an aortic dissection is going to happen. Some of the immediate and sudden symptoms can be a pain that people often describe as sharp, tearing or ripping, and it’s usually felt in the chest, back or between the shoulder blades. The symptoms can move around the body when the tear occurs and affects other organs, giving pain in the tummy, shoulders, neck and jaw, and weakness and numbness in the limbs. The lack of blood flow can dizziness, weakness, difficulty breathing and clamminess, as well as vomiting and nausea. The body can quickly go into shutdown, where you may lose consciousness and requires immediate life-saving treatment. You need to call 999.
It’s not clear exactly why it happens but certain conditions can weaken the blood vessels, putting them at more risk of aortic dissection. The most common cause is high blood pressure over a prolonged period, but also aortic aneurysm, injuries to the chest and atherosclerosis, where fatty material sticks to the inner walls of the vessels. More rare conditions like Marfan’s syndrome or bicuspid aortic valve can also weaken the vessel wall over time. It typically affects men over 65, and certain factors put your risk up, like smoking, heart surgery, damage to the valves of the aorta and even pregnancy.
Prevention is always better than cure, so addressing risk factors is the most effective way of avoiding aortic dissection. Maintaining good control of blood pressure and stopping smoking are essential for many reasons, the risk of aortic dissection being one of them. Aortic aneurysms are part of a screening process for those most at risk – in England, it’s offered to all men at 65, and they may repair any bulge found in the aorta wall to reduce the risk of rupture. The mainstay of management once you have an aortic dissection is emergency surgery to repair the aorta. There are two types of aortic dissection, depending on where in the aorta the tear occurs. Open heart surgery is required for the first type of aortic dissection (type A,) which involves a tear in the ascending aorta, the first part of the vessel stemming from the heart. Sometimes a prosthetic application may be placed to support the tear in the aorta. The second type of dissection (type B) involves the descending aorta, further down the vessel, where it passes through the chest and abdomen. This is managed with endovascular surgery, where a stent (an open tube) is placed within the vessel to support the vessel wall and repair the leak – this is less invasive than opening the chest for open heart surgery.
As blood is diverted through the tear, it builds up in the chest or abdominal cavity, and fails to reach all the most vital organs of the body – the heart, lungs, brain and kidneys, which work to keep you alive. Without treatment, aortic dissection usually causes death. Type A is more often fatal than Type B, with 1 out of 2 people not making it to hospital alive. Complications are likely and if the aorta vessel ruptures, the mortality is as high as 90% after that. Surgery greatly increases the chance of survival, although surgery comes with its own risks.