Type A aortic dissections involve the ascending aorta, which is the portion of the aorta coming directly out of the heart. This is a true surgical emergency.

Patients often describe severe, sudden chest pain that feels tearing or ripping in nature. The pain can radiate to the back or abdomen. These patients can become very unstable and may develop rupture, stroke, heart attack, aortic valve leakage, or even sudden death.

In most cases, emergency open-heart surgery is required to replace the damaged portion of the aorta and quite literally save the patient’s life.

A Type B aortic dissection occurs further down the aorta, usually beginning after the aortic arch and extending into the descending thoracic aorta.

Unlike Type A dissections, many Type B dissections can initially be treated with aggressive blood pressure and heart rate control. However, some complicated Type B dissections may also require intervention, including stent grafting of the descending aorta or, in some cases, open surgery if there is impending rupture, organ malperfusion, or rapid enlargement of the aorta.

Aortic dissections can also be classified based on timing.

An acute aortic dissection occurs within hours and represents the most dangerous phase. Subacute dissections may present weeks or even months later. Chronic dissections are sometimes discovered incidentally years afterward, although this is less common. Most often, we are dealing with acute dissections.

So who is at risk for acute aortic dissection?

The biggest risk factor is uncontrolled high blood pressure. Other important risk factors include connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome, bicuspid aortic valve disease, and family history. Certain stimulants, particularly cocaine, can also increase risk.

Diagnosis is usually made with a CT angiogram, although transesophageal echocardiography and MRI can also be useful. CTA remains the most commonly used diagnostic test.

The most important message is this: sudden, severe chest pain or back pain should never be ignored. Time matters tremendously when it comes to aortic dissection.

Early recognition and rapid transfer to an experienced center can save lives. Modern surgery and endovascular therapies have dramatically improved outcomes, but these remain among the most serious emergencies we treat.

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(𝘛𝘩𝘦 𝘷𝘪𝘦𝘸𝘴 𝘦𝘹𝘱𝘳𝘦𝘴𝘴𝘦𝘥 𝘪𝘯 𝘮𝘺 𝘱𝘰𝘴𝘵𝘴 𝘢𝘳𝘦 𝘮𝘺 𝘰𝘸𝘯 𝘢𝘯𝘥 𝘥𝘰 𝘯𝘰𝘵 𝘳𝘦𝘱𝘳𝘦𝘴𝘦𝘯𝘵 𝘵𝘩𝘦 𝘷𝘪𝘦𝘸𝘴 𝘰𝘧 𝘮𝘺 𝘦𝘮𝘱𝘭𝘰𝘺𝘦𝘳 𝘰𝘳 𝘢𝘯𝘺 𝘰𝘳𝘨𝘢𝘯𝘪𝘻𝘢𝘵𝘪𝘰𝘯.)