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Acute aortic dissection can be treated surgically or medically. In surgical treatment, the area of the aorta with the intimal tear is usually resected and replaced with a Dacron graft.
Emergency surgical correction is the preferred treatment for Stanford type A (DeBakey type I and II) ascending aortic dissection. It is also preferred for complicated Stanford type B (DeBakey type III) aortic dissections with clinical or radiologic evidence of the following conditions:
• Propagation (increasing aortic diameter)
• Increasing size of hematoma
• Compromise of major branches of the aorta
• Impending rupture
• Persistent pain despite adequate pain management
• Bleeding into the pleural cavity
• Development of saccular aneurysm
Cautions and relative contraindications to surgery include the following:
• Cerebrovascular accident (CVA)
• Severe left ventricular dysfunction
• Coagulopathy
• Pregnancy
• Previous myocardial infarction (<6 months)
• Significant arrhythmias
• Advanced age
• Severe valvular disease
Medical management remains the treatment of choice for descending aortic dissections unless they are leaking or ruptured.