Aortic Dissection

An aortic dissection occurs when the inner layer of the aortic wall tears. The inner and middle layers of the aorta separate and fill with blood, weakening the wall of the aorta. If pressure builds up, it can lead to a dangerous rupture where blood spills inside the body.

When you come to the University of Michigan Health Frankel Cardiovascular Center, you’ll find experts with decades of experience diagnosing and treating aortic dissections. We are the primary center in the area for complex dissections, offering lifesaving treatment to dozens of patients each year.

Aortic Dissection Care at the Frankel Cardiovascular Center

Within the Comprehensive Aortic Program, our unique team-based model of care provides:

  • Pioneering procedures: We’ve developed novel procedures for treating aortic dissections that are recognized worldwide.
  • Unmatched outcomes: Our outcomes for repairing Type A dissections are among the best in the country.
  • Tailored treatments: We evaluate each patient based on their condition, medical history and preferences to develop a personalized treatment plan.
  • One-on-one education: We make sure you understand your condition, treatment options and follow-up care.

Types of Aortic Dissection

Your aorta is shaped like a cane. It starts at the aortic root where it meets the left ventricle of the heart (the main pumping chamber). The aortic valve sits within the aortic root and prevents blood from flowing backward. From there, the aorta travels up (ascends) toward the head, arches 180 degrees then travels down (descends) to the abdomen.

Aortic dissections are classified by their location:

  • Type A dissections occur in the ascending aorta.
  • Type B dissections occur in the descending aorta.

Illustration of aortic dissection

Causes of Aortic Dissection

Aortic dissections can be caused by:

  • Atherosclerosis (hardening of the arteries)
  • Cocaine use
  • High blood pressure
  • Traumatic injury

Some people are born with a genetic predisposition for developing a dissection. If you have a first-order family member with an aortic dissection, you are at higher risk.

Aortic dissections are also associated with several genetic diseases and syndromes (for example, Marfan syndrome). If you have a dissection, your doctor will likely recommend meeting with our genetic counselors to discuss screening your family members.

Symptoms of Aortic Dissection

The most common symptoms of an aortic dissection include:

  • Difficulty speaking, loss of vision, weakness
  • Fainting
  • Shortness of breath
  • Sudden, severe pain in the chest, back or abdomen

A dissection that occurs in an area of the aorta with branching arteries can block blood flow to those areas:

  • If blood flow to the heart is blocked, you could have a heart attack.
  • If blood flow to the brain is blocked, you could have a stroke.

Immediate treatment is critical for dissections. Our Comprehensive Aortic Program is among the best in the nation for emergency care of patients with aortic dissections.

Diagnosing Aortic Dissection

To diagnose an aortic dissection, your doctor will ask about your medical and family history and perform a physical exam. Imaging tests help us confirm and locate the tear. These tests include:

  • Transesophageal echocardiogram (TEE): The doctorguides an ultrasound probe down your esophagus (tube that goes from your throat to stomach) to take real-time images of your aorta.
  • CT scan: This test uses powerful X-rays to produce cross-sectional views of your aorta.
  • MRI: This scan uses a magnetic field and radio waves to create detailed pictures of your aorta.

Treating Aortic Dissection

The goals of aortic dissection treatment include:

  • Treating complications (especially malperfusion syndrome)
  • Repairing the affected area
  • Preventing further tearing

To prevent further damage, your doctor will likely prescribe medication to lower your blood pressure. If surgery is not needed immediately, your doctor will also ask you to refrain from heavy lifting.

Malperfusion syndrome occurs when an aortic dissection blocks an artery that carries blood to a vital organ. If this happens, our experts use a laser inserted through a catheter (thin tube) to make holes in the blockages. This procedure restores blood flow before we repair the dissection. We developed this world-renowned procedure at the Frankel Cardiovascular Center. It greatly improves survival in patients with life-threatening dissections.

The procedure we use to repair a dissection depends on its location:

Type A Dissection Repair

Type A dissections usually require immediate repair. Our highly skilled surgeons are among the best in the country in repairing Type A dissections.

We use grafts (fabric-covered, metal mesh tubes) to replace damaged areas of the aorta. While placing a graft, our doctors may perform additional procedures to improve patient outcomes. These complex surgeries are not available at most other hospitals. They include:

  • Aortic root replacement: Dissections can occur near the aortic root, especially in people with connective tissue diseases. Our surgeons replace the aortic root and valve.
  • David procedure (valve-sparing aortic root replacement): Sometimes, when a dissection occurs near the root, the valve can be spared. We replace the root and, possibly, the ascending aorta with a graft, and then reimplant the valve. By keeping your own valve, you won’t have to take blood thinners or worry about a replacement valve wearing out.
  • Aortic arch replacement: If a dissection involves the aortic arch, our surgeons use a graft to replace the damaged area. Because major arteries branch off the aortic arch to the head, we must temporarily stop blood flow. To preserve brain function, we use a technique called hypothermic circulatory arrest to cool the body and interrupt blood flow. Once the graft is in place, we reattach the arteries to the arch.

Type B Dissection Repair

For Type B dissections, our doctors use grafts that are customized based on a patient’s anatomy. The grafts can replace a section of damaged aorta or be inserted inside the aorta to provide long-lasting support (stent graft).

Depending on the location and severity of the dissection, we may use open surgical procedures, minimally invasive endovascular techniques or a hybrid approach. Our multidisciplinary teams coordinate to determine the best treatment.

When possible, our doctors use minimally invasive techniques. These include:

  • Thoracic endovascular aortic repair (TEVAR) for a dissection in the chest. Find out more about TEVAR.
  • Endovascular aortic repair (EVAR) or fenestrated endovascular aortic repair (FEVAR) for a dissection in the abdomen. Learn more about EVAR and FEVAR.

If open surgery is needed, we may use a special cryoablation procedure to freeze the nerves around the descending aorta. This reduces postoperative pain and the use of narcotic pain medications.

Aortic Dissection Research

University of Michigan Health is a leading institution for cardiovascular research. Our faculty are working to understand the genetic basis of aortic dissection and develop new treatments.

We also maintain a registry for patients with aortic dissection through which researchers track long-term patient outcomes.

Make an Appointment

To schedule an evaluation with a Frankel Cardiovascular Center physician, call 888-287-1082. Or visit the Make a Cardiovascular Appointment page to learn what to expect when you call us.

Physicians: To refer a patient, call M-Line at 800-962-3555.