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Initial diagnosis based on CCT

Type A AAD Type B AAD

Favourable TEVAR anatomyc

Favourable TEVAR anatomyc + life expectancy >5 years OMT + surveillance

Complicated type B AAD Uncomplicated type B AAD

Open cardiac surgery

(Class I)

Endovascular repair

(Class I) Open surgical repair

(Class I)

Endovascular repair in the subacute phased

(Class IIa) OMT + more frequent

surveillance

One of the following: Contained or free aortic rupture Organ malperfusion Extension of the dissectiona Progressive aortic enlargementa

One of the following: High-risk features at CCT or CMR

Ao diameter >40 mm FL diameter >20–22 mm Entry tear >10 mm Entry tear at lesser curvature

Haemorrhagic pleural effusion Evidence of malperfusion High-risk clinical features

Refractory hypertensionb Refractory pain >12 h

Need for readmission

Total Ao diameter >5 mma

Y N

Y N

Y N

Y N

Reappearance of pain/symptoms

Figure 33 Interventional treatment algorithm in acute aortic dissection. AAD, acute aortic dissection; Ao, aorta; CCT, cardiovascular computed tomography; OMT, optimal medical treatment; TEVAR, thoracic endovascular aortic repair. aOn serial imaging in the acute phase during the hospital stay. bOngoing hypertension despite more than three classes of antihypertensive drugs. cDefined as the presence of adequate proximal and distal landing zones for the prosthesis and adequate iliac/femoral vessels for vascular access. dBetween 14 and 90 days after dissection onset.172,1226–1231 Downloaded from academic.oup.com/eurheartj/article/45/36/3538/7738955 by guest on 07 October 2026