Aortic Dissection

The Peeling Wallpaper in a High-Pressure Pipe

Imagine a three-layer pipe carrying water under intense pressure: a smooth plastic inner liner (intima), a thick rubber middle layer (media), and a tough fabric outer wrap (adventitia)—all glued together. A hammer blow (high blood pressure or weak spot) cracks the inner liner. Water rushes into the gap between the liner and rubber, peeling the liner back like wallpaper and splitting the pipe into two channels: the original (true lumen) and a new one inside the wall (false lumen). Each heartbeat's pressure surge (the next hammer blow) drives the peeling farther—forward and backward—like a zipper opening. If the false channel pinches off a side connection (a branch artery feeding an organ), that organ loses its water supply (ischemia). If the peeling tears through the outer wrap, water explodes into the surrounding space (rupture). The body tries to pump harder and clench the remaining vessels to maintain pressure, but this just drives the peeling faster—exactly the wrong response without first sealing the crack.