Perioperative Medical Management of Aortic Dissection

Surgical or endovascular repair is the cornerstone of interventional management for acute ascending aortic dissection and complicated descending aortic dissection. However, perioperative medical therapy plays a decisive role in stabilizing patients, preventing propagation of dissection and mitigating end-organ injury. Perioperative clinicians must navigate competing priorities: reducing aortic shear stress while maintaining adequate perfusion, managing severe pain and sympathetic activation, addressing malperfusion syndromes, and preparing patients for urgent or emergent intervention. This article outlines a practical framework for perioperative medical management across the continuum of care.