Acute medical management of aortic dissection

Acute aortic dissection is a life-threatening disease. Current therapeutic guidelines recommend medical therapy with aggressive blood pressure lowering for patients with acute aortic dissection, when they are not indicated for emergency surgery. In particular, patients with aortic dissection without ascending aorta involvement (Stanford type B) are treated medically, unless they have fatal complications. Patients with type B aortic dissection who have critical complications have higher early mortality than that in patients without complications. However, recent advances in thoracic endovascular aortic repair can improve the clinical outcomes in such patients. Accordingly, current guidelines recommend thoracic endovascular aortic repair for patients with complicated type B aortic dissection. However, patients with visceral ischemia still have a poor prognosis, even when they are treated with thoracic endovascular aortic repair; an early diagnosis and intervention is crucial to prevent mortality. Understanding the pathophysiological anatomy that can induce organ malperfusion might be important for an early diagnosis and intervention. This review summarizes the current state of acute medical management in patients with acute aortic dissection, based on current evidence and expert consensus, focusing on patients with type B aortic dissection.