Aortic Dissection Awareness Day 2025
Aortic Dissection Awareness Day (19 September): Why Awareness Saves Lives
Today, 19th September, was Aortic Dissection Awareness Day. I was honoured to deliver a continuing medical education talk to fellow specialists, family medicine doctors and general practitioners from IHH Singapore, comprising of healthcare professionals from Mount Elizabeth Hospital, Mount Elizabeth Novena Hospital, Gleneagles Hospital, Parkway East Hospital and Parkway Shenton primary care medical group.
Aortic dissection is a time-critical emergency that can mimic heart attack, stroke, abdominal emergencies or back pain. Delays in diagnosis cost lives, yet prompt CT scanning and expert treatment dramatically improve survival. To support public and professional awareness, I delivered this short talk on Aortic Dissection Awareness Day 2024. Below is the video and full transcript, edited for clarity. If you or a loved one develops sudden, severe chest, back, neck, or abdominal pain, Think Aorta! and seek urgent medical attention.
For appointments or more information about personalised, aortic care in Singapore, visit drandrewchoong.com/links. For more information about aortic aneurysm treatment and vascular surgery, please explore the information pages.
Transcript (edited for grammar and readability)
Aortic Dissection Awareness Day – Public Talk (2024)
Speaker: Dr Andrew Choong, Vascular, Endovascular & Aortic Surgeon, Asian Aortic & Vascular Centre (AAVC), Singapore
Opening
Good afternoon, everyone. Thank you for joining us and for taking time out of your lunch to attend this public awareness talk. Today, 19 September, is Aortic Dissection Awareness Day.
My name is Andrew Choong. I’m a vascular, endovascular, and aortic surgeon at the Asian Aortic & Vascular Centre here in Singapore. We’re streaming this session live for the first time and also recording it so you can watch it later.
A big thank-you to Medtronic, our technical team, and the AAVC operations team for making this possible.
Why awareness matters
Many people are unfamiliar with aortic dissection, and even fewer know that 19 September is Aortic Dissection Awareness Day. Events like this are designed to heighten public awareness, improve understanding, and—most importantly—improve outcomes for patients.
You can also find me on social platforms (Facebook, Instagram, X/Twitter) if you’d like to follow future updates.
A few well-known cases
There have been high-profile deaths from aortic dissection. Richard Holbrooke, President Obama’s special envoy to Afghanistan, died after delayed surgery. Perhaps more widely known is actor John Ritter, whose diagnosis was also delayed. Following his death, his family founded the John Ritter Foundation, a major patient-advocacy group promoting awareness and research into aortic disease. I’ll refer to “Ritter Rules” later.
Key facts
From the John Ritter Foundation and other sources:
Aortic dissections are preventable in many cases.
Early detection and treatment prevent premature deaths.
In the United States, roughly 20,000 people suffer an aortic dissection each year.
Up to 50% may die—an unacceptably high figure for any condition.
Survival can reach ~80% with prompt diagnosis and appropriate treatment.
What is the aorta?
The aorta is the body’s largest blood vessel. It starts at the heart, curves (the aortic arch), descends through the chest and abdomen, and supplies blood to every organ. It’s the main “pipe” moving roughly five litres of blood per minute.
What is an aortic dissection?
An aortic dissection is a medical and surgical emergency. A tear develops in the inner lining of the aorta (intima), allowing blood to split the wall layers (intima–media–adventitia). This can weaken the wall and lead to rupture.
Different mechanisms can initiate the problem (a small intimal tear, a penetrating ulcer, plaque rupture), but the result is the same—blood tracks within the wall, separates layers, and compromises blood flow.
Why presentations vary (the “great mimicker”)
Because the aorta supplies the entire body, a dissection can affect any branch:
Coronaries → heart attack/sudden death
Carotids → stroke
Arm arteries → sudden painful, cold hand
Visceral arteries (gut, kidneys, liver) → severe abdominal pain
Leg arteries → painful, cold legs
This is why dissections are often misdiagnosed. They can look like a heart attack, stroke, kidney stone, perforated bowel—almost anything. Hence the nickname: “the great mimicker.”
How serious is it?
About 20% suffer instant rupture and death.
If you reach an appropriate facility quickly, survival can be ~75–80%.
Delay kills: each hour without correct diagnosis/treatment reduces survival.
Typical survival estimates (illustrative):
0–2 hours: ~75–80% with prompt care
2–6 hours: ~65%
7–12 hours: ~60%
>24 hours without correct management: ~50% mortality
Why diagnosis is delayed
A CT scan of the chest/abdomen is the definitive test. Delays happen because symptoms mimic other conditions, patients are triaged to the wrong pathway, or early tests (ECG, bloods, X-ray) appear non-specific.
This is why awareness campaigns emphasise a simple message:
Unexplained, severe pain? Think Aorta. Get a CT.
Common symptom locations: neck, back, chest, abdomen—often described as sudden, tearing or ripping pain unlike anything experienced before.
Risk factors include: hypertension, certain genetic conditions (e.g., Marfan syndrome, Ehlers–Danlos), bicuspid aortic valve, smoking, age, and male sex.
Ritter Rules (key takeaways)
Aortic dissection is a medical emergency.
Mortality increases ~1% per hour with delays in diagnosis/repair.
Seek immediate emergency care for sudden, severe pain in the chest, back, abdomen, or neck—especially if it’s tearing/ripping/migratory or feels “very wrong.”
CT angiography confirms the diagnosis.
Types of dissection (briefly)
Type A: starts in the ascending aorta; usually requires open surgery.
Type B: starts in the descending aorta; often managed with endovascular stent-graft repair (my subspecialty), depending on complications.
How we treat dissections (endovascular overview)
There’s typically an entry tear. By placing a stent-graft (delivered through the leg via keyhole access), we seal the entry, redirect flow into the true lumen, and allow the aorta to remodel. Modern stent-grafts are made from durable fabric supported by nitinol (a nickel-titanium alloy).
Aneurysms and dissection
A dissection weakens the aortic wall, which can later balloon into an aneurysm.
Treatment options:
Open repair: replace the diseased segment with a surgical graft.
Endovascular repair (EVAR/TEVAR): stent-graft lined from within; often with a “trouser-leg” bifurcated device in the abdomen.
Key reminders
Unexplained severe pain? Think Aorta.
Aortic dissection is an emergency and often fatal if missed.
CT scanning is the definitive diagnostic tool.
Vascular/aortic surgeons are available across Singapore in both public and private sectors.
For appointments or information: drandrewchoong.com/links.
Q&A (selected)
Q: How long does a stent last?
A: The goal is for the stent-graft to last the patient’s natural life. Over decades, the native aorta (not the stent itself) may degenerate further, occasionally requiring additional interventions.
Q: How many stents are usually needed?
A: It depends on extent and anatomy. Many dissections need one to two components; complex aneurysms may need three to five components.
Q: Why does dissection happen?
A: Genetics (e.g., Marfan, Ehlers–Danlos), population differences, and especially uncontrolled high blood pressure. Other cardiovascular risks—smoking, age, male sex, cholesterol—also contribute.
Q: When is an aortic root replacement (“Bentall procedure”) needed?
A: If a dissection involves the aortic root, compromising the coronary arteries or aortic valve, open surgery may replace the root, valve, and reimplant the coronaries.
Q: Should we screen regularly?
A: Screening won’t usually catch an acute dissection, which strikes suddenly. However, a one-time abdominal aortic aneurysm ultrasound is sensible for men ≥55 or anyone at increased risk. It’s simple and non-invasive.
Q: Can we treat a dissection with medication alone?
A: Selected patients—usually uncomplicated Type B—can be managed with aggressive blood-pressure control and close specialist surveillance. The approach must be individualised by an aortic team.
Q: Do blood thinners (e.g., daily aspirin) increase dissection risk?
A: They don’t cause dissection but can worsen bleeding if one occurs. This is why misdiagnosis (e.g., treating presumed stroke/MI with strong blood thinners) can be dangerous in undetected dissection.
Q: What symptoms suggest an aneurysm?
A: Sometimes pain or a pulsatile abdominal lump. Classic teaching: a man in his mid-60s with sudden severe back/abdominal pain—exclude an aortic cause. The aorta runs along the spine; irritation there often presents as back pain.
Final note: If you experience sudden, severe, unexplained pain—especially in the chest, back, neck, or abdomen—Think Aorta and seek emergency care.
For consultations or referrals: drandrewchoong.com/links.