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Aortic dissections
Aortic dissections can cause aortic aneurysms or result from them. An aortic dissection begins with a tear through the inner layer into the middle layer of the aortic wall. This causes the layers of the aortic to separate like plywood that has been left outside in the weather.
This separation within the wall (dissection) of the aorta causes the wall of the aorta to weaken, often enlarging the aorta, forming an aneurysm as shown in this picture. Frequently, a second tear forms farther along the aorta; that opens a path for the blood to get back into the vessel, forming a side channel for blood flow in the lining of the aorta and creating a "double-barreled" aorta.
Dissections can occur anywhere along the aorta or involve the entire aorta. Blood leaking into a dissection near the heart may cause a cardiac tamponade-a life-threatening condition where blood enters the lining around the heart, preventing the heart from filling properly. If the tear progresses completely through the aorta, death can occur in a matter of minutes.
When the aorta dissects, severe pain in the chest or back occurs, which is often described as a tearing discomfort––"the worst pain I've ever had," many patients say. This usually sends the person to the emergency room where the diagnosis can be made. If left untreated, most aortic dissections are fatal.
The risk of death depends upon the extent of the dissection. The risk is highest for dissections that involve the ascending aorta. For that reason, most aortic dissections along the ascending aorta are treated immediately with surgery. Occasionally, some specific variations of dissections along the descending thoracic aorta may be treated with medication. Click here for more information on treatment of aortic dissection.
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