ABSTRACT
Acute dissection is one of the most common lethal conditions of the aorta, with a mortality rate (1.2 to 1.5/100,000 males) slightly less than that reported for ruptured aortic aneurysms. The initial abnormality in aortic dissection is a tear in the wall of the aorta allowing blood to dissect into the media, separating the intimal layer and the adventitial layer of the vessel. The majority of patients with acute aortic dissection experience sudden onset of intense interscapular pain. The pain is presumably caused by intimal tearing in well-innervated large vessels. The pain frequently migrates to the lower back and abdomen. Any unexplained chest pain, especially if radiating to the back or abdomen in an older hypertensive man, should include acute aortic dissection as part of the diagnostic differential in addition to MI and ischemia. Descending (type B) aortic dissection management is rapidly evolving.
