Ask a Doctor: Robert J. Feezor, UF Health Vascular Surgeon on Aortic Dissections

Understanding Aortic Dissection 

An aortic dissection is a serious and potentially life-threatening condition that occurs when a tear develops in the wall of the aorta, the body's largest artery. Because symptoms can vary widely and may mimic other medical emergencies, recognizing the warning signs and seeking immediate care is critical. We spoke with vascular surgeon Robert J. Feezor, MD, to learn more about this dangerous condition, who is at risk, and how it can be treated. 

Q: What is an aortic dissection? 

Dr. Feezor: An aortic dissection occurs when a tear develops in the wall of the aorta, the large blood vessel that carries blood from the heart to the rest of the body. Blood can enter through that tear and separate the layers of the aortic wall. Depending on where the tear occurs, it can be extremely dangerous and, in some cases, cause sudden death. 

Q: What symptoms should people watch for? 

Dr. Feezor: The classic symptom is severe chest pain that radiates to the back. However, aortic dissection has earned the nickname "the Great Masquerader" because it can present in many different ways. Some patients have symptoms that resemble a stroke, while others may appear to be having a heart attack. It can also cause symptoms similar to a spinal cord injury, lower back pain, or even leg pain. Because the presentation can be so varied, it's important not to dismiss sudden, severe symptoms. 

Q: Who is at the highest risk for an aortic dissection? 

Dr. Feezor: The most common risk factor is uncontrolled high blood pressure. People who are born with congenital or inherited conditions that affect the aorta are also at higher risk. In addition, illicit drug use, particularly cocaine and methamphetamines, can significantly increase the likelihood of experiencing an aortic dissection. 

Q: How is an aortic dissection different from a heart attack? 

Dr. Feezor: They're very different conditions. A heart attack occurs when the blood vessels that supply the heart muscle become blocked. An aortic dissection involves a tear in the aorta itself, the main artery carrying blood from the heart to the rest of the body. While some symptoms may overlap, the underlying cause and treatment are completely different. 

Q: What should someone do if they think they or a loved one may be experiencing an aortic dissection? 

Dr. Feezor: Seek medical attention immediately. Call 911 and go directly to the Emergency Department. Time is critical. Once a patient arrives, physicians can quickly begin controlling blood pressure with intravenous medications and obtain imaging, such as a CT scan, to evaluate the aorta and confirm the diagnosis. 

Q: Can anything be done to lower the risk of an aortic dissection? 

Dr. Feezor: Absolutely. Managing blood pressure is one of the most important preventive measures. Avoiding illicit drug use is also critical. Additionally, understanding your family medical history can help identify inherited risks. For individuals with a family history of aortic disease, screening may include ultrasound imaging, CT scans, and in some cases, genetic testing. 

Q: How are aortic dissections treated? 

Dr. Feezor: Treatment depends on the type and location of the dissection. Some cases require emergency surgery. Fortunately, advances in vascular treatment now allow certain dissections to be repaired using minimally invasive techniques that reline the aorta with a stent. The sooner the condition is diagnosed, the more treatment options may be available. 

Q: What is the most important message you want people to remember? 

Dr. Feezor: Aortic dissection can appear in many different ways and should never be ignored. It truly is "the Great Masquerader." Prompt diagnosis and treatment can be lifesaving. And once someone has been diagnosed with an aortic dissection, lifelong monitoring and follow-up care with a vascular surgeon or cardiac surgeon are essential. 

Bottom Line: Aortic dissection is a medical emergency that can mimic several other serious conditions. Recognizing the symptoms, understanding your risk factors, and seeking immediate medical care can make all the difference. As Dr. Feezor emphasizes, awareness and rapid treatment are key to saving lives.