Aortic dissection occurs when a tear in the inside of the aorta causes blood to flow between the layers of the wall of the aorta, forcing the layers apart. In most cases this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. There may also be vomiting, sweating, and lightheadedness. Other symptoms may result from decreased blood supply to other organs such as stroke or mesenteric ischemia. Aortic dissection can quickly lead to death as a result of not enough blood flow to the heart or rupture of the aorta. Aortic dissection is more common in those with a history of high blood pressure, a number of connective tissue diseases that affect blood vessel wall strength such as Marfan syndrome, a bicuspid aortic valve, and previous heart surgery. Major trauma, smoking, cocaine use, pregnancy, a thoracic aortic aneurysm, inflammation of arteries, and abnormal lipid levels also increase the risk. The diagnosis is confirmed with medical imaging such as computed tomography, magnetic resonance imaging, or ultrasound. There are two main types, Stanford type A which involve the first part of the aorta and type B which do not. Prevention is by blood pressure control and not smoking. The treatment of aortic dissection depends on the part of the aorta involved. Surgery is usually required for dissections that involve the first part of the aorta, while those that do not can typically be treated with blood pressure and heart rate lowering unless complications result. Surgery may be done either by an opening in the chest or by endovascular aneurysm repair (carried out from inside the blood vessels). Aortic dissection is relatively rare, occurring at an estimated rate of 3 per 100,000 people every year. It is more common in males than females. The typical age at diagnosis is 63, with about 10% of cases occurring before 40. Without treatment about half of people with type A die within three days and about 10% of people with type B die within a month. The first case of aortic dissection described was in the examination of King George II of Great Britain following his death in 1760. Surgery for aortic dissection was introduced in the 1950s by Michael E. DeBakey.

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