While some types of aortic dissections do not require emergent
surgery, the majority do. An aortic dissection is a serious and
life-threatening condition. The decision regarding appropriate
treatment should be made in consultation with an experienced
surgeon who specializes in the treatment of aortic disease.
If the dissection is acute--occurring less than 2 weeks prior--
and involves the more proximal portions of the aorta, (eg, the
root, ascending aorta, or aortic arch), emergent surgery is
generally required. If the dissection involves the more distal
aorta (eg, descending thoracic aorta or abdominal aorta), strict
blood pressure is typically recommended. Surgery may be recommended
for dissections of the distal aorta when it is believed to be the
cause of ongoing back or abdominal pain, renal damage, paralysis,
bowel ischemia, limb ischemia, or aortic rupture. Surgery may also
be recommended when the aorta is significantly enlarged.
If an aortic dissection is found (or suspected), strict blood
pressure control is needed with a target mean arterial pressure of
60-75 mmHg. Beta blockers (e.g. Esmolol, Propranolol, or Labetalol)
are first-line treatment. Calcium-channel blockers (e.g. Verapamil
and Diltiazem) can be used, particularly if there is a
contraindication to beta blockers. Vasodilators (e.g. Sodium
nitroprusside) can be used for refractory hypertension, but they
never should be used without beta- or calcium-channel blockers.
Vasodilators, including Hydralazine and Minoxidil, and
beta-blockers that have intrinsic sympathomimetic action (e.g.
Acebutolol, Pindolol) should be avoided.