How are dissections that involve the ascending aorta managed differently from those that involve the descending aorta only?
Dissections involving the ascending aorta (Stanford type A and DeBakey types 1 and 2) are surgical emergencies because mortality is significantly greater in medically managed patients (approximately 90% in the first 3 months) compared with surgically treated patients.
This high mortality rate is mostly due to hemopericardium causing cardiac tamponade, acute aortic regurgitation, or involvement of coronary artery origins with acute myocardial infarction.
Descending aortic dissections are usually treated medically (with antihypertensive agents) because morbidity and mortality are greater with surgery than with medical management.
Complicated descending aortic dissections may require surgical or endovascular intervention, however.