Pathophysiology

Above the aortic root

Aortic arch

Distal to left subclavian artery

Transverse tear in the aortic intima (“entry”) → blood enters the media of the aorta and forms a false lumen in the intima-media space → hematoma forms and propagates longitudinally downwards

• Rising pressure within the aortic wall → rupture

• Occlusion of branching vessels (e.g., coronary arteries, arteries supplying the brain, renal arteries, arteries supplying the lower limbs) → ischemia in the affected areas

• A second intimal tear may result in a “reentry” into the primary aortic lumen.