This protocol covers acute aortic dissection not involving the ascending aorta (Stanford type B) when it is complicated by high-risk features — including rupture, branch artery occlusion or malperfusion, extension of the dissection, aortic enlargement, intractable pain, or uncontrolled hypertension. These complications significantly raise the risk of morbidity and death and may require urgent or emergency intervention.
Type B dissection encompasses all dissections that spare the ascending aorta. When complicated features are present at initial presentation — or develop subsequently — patients face substantially elevated risk and the threshold for urgent action is lower. Intervention is recommended in the setting of rupture or other defined complications.
Prompt anti-impulse therapy delivered in an ICU setting, with invasive blood pressure monitoring via an arterial line, is the cornerstone of initial treatment to reduce aortic wall stress. Management involves intravenous agents to control both heart rate and blood pressure; the specific agent selection and full treatment algorithm are available in the complete protocol.
Systolic blood pressure <120 mm Hg (or the lowest BP that maintains adequate end-organ perfusion) and heart rate of 60 to 80 bpm.
DOI: 10.1161/CIR.0000000000001106
Type B: All dissections that do not involve the ascending aorta (including dissections that involve the aortic arch but spare the ascending aorta).
In patients with acute type B aortic dissection and rupture or other complications, intervention is recommended.
Patients presenting with complicated acute type B aortic dissection, or developing such features after initial presentation, have an increased risk of morbidity and death, and urgent or emergency intervention may be required.
In patients presenting to the hospital with AAS, prompt treatment with anti-impulse therapy with invasive monitoring of BP with an arterial line in an ICU setting is recommended as initial treatment to decrease aortic wall stress.
This is usually accomplished with a combination of intravenous beta blockers and vasodilators with the goal of reducing both heart rate and BP to decrease aortic wall stress.
Patients with AAS should be treated to an SBP <120 mm Hg or to lowest BP that maintains adequate end-organ perfusion, as well as to a target heart rate of 60 to 80 bpm.
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