General Principles

Patients with suspected dissection are often in pain and opiate analgesia is important both for comfort and to reduce the sympathetic response to pain which itself can cause progression of the dissection process.

Definitive treatment depends upon the type of dissection:

• Type A dissections require open surgery to prevent rupture into the pericardial sac
• Type B dissections are managed medically but may require endovascular stenting if the patient has persistent pain, a rapidly expanding aortic diameter, or malperfusion of branch vessel organs

It is important that patients with a Type B dissection are still managed in a High Dependency Unit and referred to a vascular interventional team if complications arise [3,4].