Acute Aortic Dissection

The treatment of patients with acute aortic dissection must begin as soon as the diagnosis is first suspected. Aggressive measures to lower the systemic blood pressure and its rate of increase (dP/dt), usually with intravenous beta-blockade in combination with sodium nitroprusside, should be instituted immediately, even before confirmatory imaging studies are performed. Patients with type A dissection are best managed with emergency surgery, whereas patients with type B dissection should be treated medically unless complications intervene. There is a growing experience with catheter-based techniques, including fenestration, stenting, and endoluminal graft insertion, for the management of selected patients with acute dissection. Regardless of the initial treatment strategy adopted, hospital survivors should continue strict antihypertensive therapy, and a schedule of surveillance imaging studies should be established.