Acute Aortic Dissection — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Confirm & classify
   Stanford type? (Sudden severe tearing chest/back pain, asymmetric pulses or BP, widened mediastinum. CTA (first-line if stable) confirms; untreated mortality rises 1–2% per hour. Stanford A = involves the ascending aorta; B = descending only (distal to the left subclavian). Start anti-impulse therapy for all types.)
   • Stanford A (ascending aorta involved) → Type A → emergency surgery
   • Stanford B (descending only) → Type B → mainly medical
2. [End] Type A → emergency surgery
   Anti-impulse stabilization first, then emergency surgical repair (type A is a surgical emergency): IV beta-blocker (esmolol/labetalol) to HR 60–80 and SBP <120 (or the lowest that maintains organ perfusion); add a vasodilator (nicardipine/nitroprusside) only after beta-blockade if BP remains high; full analgesia. Immediate cardiac surgery consult; malperfusion makes immediate surgery even more urgent.
3. [End] Type B → mainly medical
   Anti-impulse medical therapy mainly: IV beta-blocker to HR 60–80 and SBP <120, add a vasodilator after beta-blockade if needed; analgesia, monitoring. Complicated type B (malperfusion, rupture/impending rupture, refractory pain or hypertension, rapid expansion) → endovascular repair (TEVAR)/surgery. If beta-blockers are contraindicated (severe acute aortic regurgitation, shock), use a non-dihydropyridine CCB instead.

Source guidelines & references

• 2022 ACC/AHA Guideline for the diagnosis and management of aortic disease. Circulation 2022

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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