In an acute<unk> , treatment choice depends on its location. For Stanford type A (ascending<unk> , surgical management is superior to medical management. For uncomplicated Stanford type B (distal<unk> s (including abdominal<unk> s), medical management is preferred over surgery. Complicated Stanford type B<unk> s require surgical intervention after initiation of medical therapy. The risk of death due to<unk>  is highest in the first few hours after the<unk>  begins, and decreases afterward. Because of this, the therapeutic strategies differ for the treatment of an acute<unk>  compared to a chronic<unk> . An acute<unk>  is one in which the individual presents within the first two weeks. If the individual has managed to survive this window period, their prognosis is improved. About 66% of all<unk> s present in the acute phase. Individuals who present two weeks after the onset of the<unk>  are said to have chronic<unk> s. These individuals have been self-selected as survivors of the acute episode and can be treated with medical therapy as long as they are stable. Medication<unk>  generally presents as a hypertensive emergency, and the prime consideration of medical management is to decrease the shear stress in the aortic wall (dP/dt (force of ejection of blood from the left ventricle)) by decreasing blood pressure and the heart rate. The target blood pressure should be a mean arterial pressure (MAP) of 60 to 75 mmHg, or the lowest blood pressure tolerated. Initial decreases should be by about 20%. The target heart rate is less than 65 beats per minute. Long-term blood pressure control is required for every person who has experienced<unk> . Beta blockers are the first-line treatment for patients with acute and chronic<unk> . In acute<unk> , fast-acting agents can be given intravenously and have doses that are easier to<unk> just (such as esmolol, propranolol, or labetalol) is preferred. Vasodilators such as sodium nitroprusside can be considered for people with ongoing high blood pressure, but they should never be used alone, as they often stimulate a reflexive increase in the heart rate. Calcium channel blockers can be used in the treatment of<unk> , particularly if a contraindication to the use of beta-blockers exists. The calcium channel blockers typically used are verapamil and diltiazem, because of their combined vasodilator and negative inotropic effects. If the individual has refractory hypertension (persistent hypertension on the maximum doses of three different classes of antihypertensive agents), involvement of the renal arteries in the<unk>  plane should be considered. Surgical Indications for the surgical treatment of<unk>  include an acute proximal<unk>  and an acute distal<unk>  with one or more complications. Complications include compromise of a vital organ, rupture or impending rupture of the aorta, retrograde<unk>  into the ascending aorta. These are more common with a history of Marfan syndrome or Ehlers-Danlos syndrome. The objective in the surgical management of<unk>  is to resect (remove) the most severely damaged segments of the aorta and to obliterate the entry of blood into the false lumen (both at the initial intimal tear and any secondary tears along the vessel). While excision of the intimal tear may be performed, it does not significantly change mortality. The particular treatment used depends on the segment or segments of the aorta involved. Some treatments are: * Open aortic surgery with replacement of the damaged section of the aorta with a tube graft (often made of Dacron) when no damage to the aortic valve is seen * Bentall procedure – replacement of the damaged section of the aorta and replacement of the aortic valve * David procedure – replacement of the damaged section of the aorta and reimplantation of the aortic valve * Thoracic endovascular aortic repair, a minimally invasive surgical procedure usually combined with ongoing medical management * Replacement of the damaged section of the aorta with a sutureless vascular ring connector-reinforced Dacron graft: The vascular ring connector is a titanic ring used as a stent in the vascular graft to achieve a quick, blood-sealed, and sutureless anastomosis. Two furrows on the surface of the ring are for fixation of the vascular graft and the aorta. The tapes used to tie against the ring provide a larger contact surface area than the traditional stitches, thus it provides stronger anastomosis and better surgical results. A number of comorbid conditions increase the surgical risk of repair of an<unk> . These conditions include the following: * Prolonged preoperative evaluation (increased length of time prior to surgery) *<unk> vanced age * Comorbid disease states (e.g.: coronary artery disease) * Aneurysm leakage * Cardiac tamponade * Shock - obstructive shock * Past history of myocardial infarction * History of kidney failure (either acute or chronic kidney failure) Follow-up Closure of the lumen of a Type B<unk>  following medical management The long-term follow-up in individuals who survive<unk>  involves strict blood pressure control. The relative risk of late rupture of an aortic aneurysm is 10 times higher in individuals who have uncontrolled hypertension, compared to individuals with a systolic pressure below 130 mmHg. The risk of death is highest in the first two years after the acute event, and individuals should be followed closely during this time period. About 29% of late deaths following surgery are due to rupture of either a<unk> g aneurysm or another aneurysm. In<unk> dition, a 17% to 25% incidence exists of new aneurysm formation, typically due to dilatation of the residual false lumen. These new aneurysms are more likely to rupture, due to their thinner walls. Serial imaging of the aorta is suggested, with MRI being the preferred imaging technique.
Aortic dissection
Costochondritis
Aortic rupture
Tietze syndrome  Tietze syndrome  1
Acute aortic syndrome
Thoracic aortic aneurysm
Aortoenteric fistula
Myocardial rupture