2.Definitive Medical Management
Definitive medical therapy is indicated for uncomplicated, acute distal aortic dissection because survival rate in this group of patients is greater than 90%. It is also indicated for stable, isolated arch dissection because surgery to repair the arch of the aorta is extremely difficult. Medical treatment is also advised for stable, uncomplicated dissection presenting more than two weeks after onset of symptoms.
3. Surgical Management
Surgical risk is increased by age and the presence of concomitant diseases, particularly respiratory failure caused by severe chronic bronchitis and emphysema. Renal failure, cardiac tamponade, or cardiogenic shock also increases surgical risk. Surgery is the treatment of choice for acute proximal dissection, acute distal dissection complicated by rupture or impending rupture, and dissection in Marfan syndrome.

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