4th June 2026

Surgical management

Indications for surgery: Type A (Stanford) dissection, persistent pain, Branch occlusion, Leak, Continued extension of the dissection despite medical management. 

• Type A dissection – Requires urgent open surgery to prevent rupture of the aorta and the pericardial sac. It will involve replacement of the ascending aorta with a synthetic graft. 
• Type B dissections – Requires medical management if uncomplicated, however they may require stenting (endovascular) if there are complications such as poor perfusion of end organs, continuous pain, an aortic diameter that is rapidly expanding or aortic rupture/impending rupture.

The endovascular management is sometimes known as TEVAR (thoracic endovascular aortic repair), which aims to completely occlude the initial entry tear via stenting. Balloon fenestration can also be used. If aortic rupture or organ malperfusion occurs, then the stenting must occur urgently (<24 hours), however other complications may be surgically managed within 14 days. If a dissection is managed with endovascular repair, it is advised to have a surveillance CT scan done at 4 weeks, before annual surveillance.

Medical management of uncomplicated type B dissections includes tight control of blood pressure and analgesia, with continuous CTA imaging to monitor further complications is advised at 2-3 days post-event, 1 week and then 1 month. Annual surveillance may then be indicated.