Arterial & Aortic Dissection

Dissection can narrow the true channel, interrupt blood flow to branch arteries, or weaken the artery and contribute to aneurysm formation. Depending on severity, it may require monitoring, medication, endovascular treatment or open repair.

Once blood enters the wall it creates a false channel alongside the true one, and the balance of flow between the two determines which organs or limbs are affected. Dissection may involve the aorta itself or a peripheral, renal, mesenteric or other artery, which is why presentations range from an incidental imaging finding to catastrophic emergency.

Aortic dissection

Aortic dissection may involve the ascending aorta, aortic arch, descending thoracic aorta or abdominal aorta. Classification and treatment depend largely on whether the ascending aorta is involved and whether there are complications such as organ ischaemia, rupture or uncontrolled pain.

Sudden severe chest or back pain, collapse, neurological symptoms or loss of circulation to a limb require emergency care through Triple Zero (000).

Peripheral and visceral artery dissection

Dissection can affect the arteries supplying the limbs, kidneys or bowel. It may arise spontaneously, after injury or following a catheter-based procedure.

Symptoms depend on the artery involved and may include limb pain, abdominal pain, reduced kidney function or signs of organ ischaemia.

Risk factors

High blood pressure, inherited connective tissue disorders, bicuspid aortic valve disease, aortic enlargement, pregnancy-related vascular changes, trauma and previous arterial procedures may increase risk.

Symptoms depend on the artery involved. Aortic dissection classically causes sudden, severe chest or back pain, sometimes described as tearing, and may be accompanied by pulse differences between limbs, fainting, neurological symptoms or signs of organ or limb ischaemia.

Dissection of a peripheral or visceral artery may cause limb pain, abdominal pain or reduced kidney function, while some limited dissections cause nothing at all and are found incidentally. Sudden severe chest, back, abdominal or limb pain warrants Triple Zero (000), not observation at home.

CT angiography is the key investigation because it rapidly shows the extent of the dissection, the true and false lumens, which branch vessels are involved and whether complications such as rupture or organ ischaemia are present. Ultrasound, MRI and catheter angiography have roles in selected situations and in follow-up.

Assessment also covers blood pressure history, connective tissue conditions, family history of aortic disease and any previous arterial procedures, because these shape both the immediate management and the long-term surveillance plan.

Management spans a wide range: stable, uncomplicated dissections may need only strict blood pressure control and surveillance imaging, while complicated dissections require urgent repair. Intervention is generally considered for rupture, impaired blood flow to organs or limbs, rapid expansion or persistent uncontrolled pain.

Medical management

Stable uncomplicated dissections may be managed with close monitoring and strict blood pressure control. Medication reduces force on the arterial wall, and treatment addresses other cardiovascular risk factors.

Endovascular treatment

Stent grafts or other endovascular techniques can seal an entry tear, restore flow to the true lumen or treat an associated aneurysm. Branch vessel stenting may be required when organ or limb blood flow is compromised.

Open surgery

Open repair is required for many ascending aortic dissections and may be necessary for rupture, unsuitable anatomy or complex branch vessel involvement. Treatment often requires collaboration between vascular and cardiothoracic surgeons.

Major dissections can cause rupture, stroke, kidney injury, bowel ischaemia or limb loss, and treatment decisions are highly individual because anatomy and consequences vary so widely between patients.

Dissection is a lifelong arterial condition even when the acute phase settles. Ongoing care centres on strict blood pressure control and scheduled imaging to watch for aneurysmal enlargement of the weakened segment, with prompt review of any new pain or neurological symptoms.

After a dissection, useful questions include which segment of the artery is involved, whether the dissection is currently stable, and what blood pressure target you should aim for and how it will be monitored.

You may also want to ask how often surveillance scans are needed, what changes on imaging would prompt intervention, whether relatives need assessment for inherited arterial conditions, and what activity or lifting restrictions apply. Bring your current medication list.

A dissection that needed no operation still needs lifelong attention: blood pressure control and surveillance imaging are the treatment. Conversely, an intervention does not end follow-up, because the remaining artery can enlarge over time. Your surgeon will explain how these principles apply to your particular anatomy so decisions are made together at each stage.

Yarra Vascular Surgeons manages the full spectrum of dissection, from surveillance and medical therapy for stable disease to endovascular stent grafting and open repair for complicated cases, working with cardiothoracic and other specialist teams where the ascending aorta or complex branch anatomy is involved. Structured imaging follow-up continues for the long term.

Arterial dissection ranges from stable disease requiring surveillance to life-threatening aortic or branch-vessel complications. Yarra Vascular Surgeons provides detailed assessment of anatomy, organ or limb blood flow and progression risk, with access to medical management, endovascular repair, open surgery and multidisciplinary planning. Sudden severe chest, back, abdominal or limb pain requires emergency assessment through Triple Zero (000).