Contemporary management of acute aortic dissection

The development of endovascular techniques has introduced a new dimension to the management of acute aortic dissection. Conventional therapy has traditionally been relegated to patients who experience severe clinical sequelae; unfortunately, clinicians have not been able to accurately predict the clinical consequences of a dissection. However, recent attention to true and false lumen characteristics, the distal extent of the dissection, and branch vessel involvement has demonstrated that these independent predictors of outcome can serve as surrogate indications for endovascular or surgical treatment. We review the pathophysiological mechanisms associated with the sequelae of aortic dissection and summarize the treatment paradigms we have developed.