Acute aortic dissection requires urgent treatment because early mortality is approximately 1%–5% per hour.
Initial treatment and dissection type
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Initial management comprises pain control and antihypertensive treatment.
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Type A dissections require emergency surgery to replace the ascending aorta.
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Type B dissections are treated medically unless there is actual or impending external rupture, vital organ ischaemia involving the gut or kidneys, or limb ischaemia. Surgery carries very high morbidity and mortality.
Blood pressure control
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Medical management aims for a mean arterial pressure of 60–75 mmHg to reduce the force of blood ejection from the left ventricle.
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β-blockers are first-line therapy. Labetalol is especially useful because it also has α-blocking properties.
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Rate-limiting calcium channel blockers such as verapamil or diltiazem are used when β-blockers are contraindicated.
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Sodium nitroprusside may be considered if these treatments fail to control blood pressure adequately.
Endoluminal repair
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Percutaneous or minimal access endoluminal repair is sometimes possible.
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Fenestration perforates the intimal flap, allowing blood to return from the false lumen to the true lumen and decompressing the false lumen.
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An alternative is implantation of a stent graft introduced from the femoral artery.