Aortic Dissection: Risk Factors, Symptoms, Screening, and Treatment

Aortic dissection has been in the news and many are wondering what it is, who is at risk, and whether it can be detected before becoming life threatening.

“Most people think of aortic dissection as a rare condition, but it’s more common than many realize,” says Joseph Bavaria, MD, the Anthony E. Narducci Professor and Chair of Cardiac Surgery and Executive Director of the Bruce & Robbi Toll Heart and Vascular Institute, and an international expert on dissection and aortic diseases.

An aortic dissection occurs when a tear develops in the inner layer of the aorta, the body’s largest artery. The condition can quickly become life threatening and requires immediate medical attention.

While there is no way to determine who might develop an aortic dissection, there are risk factors and underlying conditions that can be managed to help lower your risk. 

Men over the age of 60 are most at risk, as are people who smoke, have a family history of dissection or aneurysm, or have a genetic disorder such as Marfan syndrome or Loeys-Dietz syndrome. 

“The most significant risk factor is uncontrolled high blood pressure,” Dr. Bavaria says. Despite men being most affected by aortic dissection, it’s common in women too, and they often have worse outcomes than men once treatment becomes necessary. “It’s certainly not something women should dismiss,” he adds.

Unlike some cardiovascular conditions, there is no routine screening test for aortic dissection because the tears usually occur suddenly. Instead, physicians look for conditions that increase the risk for dissection — an ascending aortic aneurysm or bicuspid aortic valve disease. “One in approximately 200 people has bicuspid aortic valve disease, which can lead to enlargement of the aorta and increase the risk of future complications,” Dr. Bavaria says.

Echocardiogram is typically the first imaging test used to evaluate the aorta. MRI or computed tomography angiography may be recommended when additional evaluation is needed.

The goal is to identify and manage risk factors before an aortic dissection occurs.

• Keep blood pressure under control

• Don’t smoke

• Maintain a healthy weight

• Exercise regularly, but get your physician’s recommendations

• Avoid significant straining or heavy lifting if you have a risk factor for dissection

Clinicians monitor known ascending aortic aneurysms with recurring imaging studies. If an aortic aneurysm continues to grow and is at risk for tearing, a cardiothoracic surgeon can repair it using a stent or synthetic graft.

Jefferson Health offers an extensive range of aortic care including open, endovascular, and minimally invasive repair procedures to treat ascending aortic aneurysm. Jefferson’s heart and vascular services were further strengthened when they came together with Lehigh Valley Health Network in 2024 led by Benjamin Jackson, MD, clinical lead for vascular surgery for the Bruce & Robbi Toll Heart and Vascular Institute, and Chief, Division of Vascular and Endovascular Surgery, Lehigh Valley Heart and Vascular Institute. World-renowned heart surgeon Edward Chen, MD, also recently joined Jefferson Abington Hospital. 

“The best thing people can do is know their family history and know their blood pressure results,” Dr. Bavaria says. “If you have high blood pressure or high cholesterol, work with your physician to keep those under control.”

People with aortic dissection frequently describe experiencing:

• Sudden, severe chest pain
• Severe back pain
• A ripping, tearing or stabbing sensation
• Symptoms that can resemble a heart attack

While emergency treatment is critical, Dr. Bavaria emphasizes the importance of identifying risk factors before a dissection occurs. 

He identified several key risk factors:

• Uncontrolled high blood pressure
• Smoking
• Family history of dissection or aneurysm
• Genetic conditions such as Marfan syndrome or Loeys-Dietz syndrome
• Age, particularly adults over 60

Dr. Bavaria also explained that while there is no routine screening test for aortic dissection itself, physicians can identify conditions that increase risk, including ascending aortic aneurysms, bicuspid aortic valve disease, and other structural abnormalities of the aorta.

For Dr. Bavaria, awareness starts with understanding personal risk.

“The best thing people can do is know their family history and know their blood pressure results. If you have high blood pressure or high cholesterol, work with your physician to keep those under control.

He recommends that you:

• Monitor and manage blood pressure
• Avoid smoking
• Maintain a healthy weight
• Exercise under physician guidance
• Follow medical recommendations for surveillance imaging when appropriate