Symptoms include sudden thoracic or abdominal pain which may radiate to head, back, pelvic region, lower extremities, and rarely arms. Varying degrees of shock with loss of consciousness can occur. Moderate fever, leukocytosis, and death can occur from rupture. Causes of dissection include hypertension, Marfan s syndrome, trauma, Ehler s Danlos, coarctation, bicuspid aortic valve and relapsing polychondritis. The tear occurs most frequently 1-2 cm above the aortic valve and at the isthmus near the attachment of the ligamentum arteriosum.
Dissection begins as an intramural hematoma arising from ruptured vasa vasorum.
Ischemia of the aortic media is the primary factor in medionecrosis. De Bakey separates aortic dissections into three subtypes. Stanford A involves the ascending and B involves the descending aorta. The gold standard has long been angiography which is invasive and has associated morbidity and high radiation exposure. It remains popular at many institutions, primarily because of its preference by referring surgeons.