A 62-year-old man presents with sudden onset severe tearing chest pain radiating to the back. CT aortography shows a Stanford Type A aortic dissection (involving the ascending aorta). The management is:

• A Medical management with beta-blockers and sodium nitroprusside to achieve a target systolic BP of 100–120 mmHg
• B Urgent surgical repair of the ascending aorta under cardiopulmonary bypass ✓
• C TEVAR (thoracic endovascular aortic repair) as the first-line intervention
• D TEVAR for the entry tear plus medical therapy for the ascending component

Explanation

Stanford Type A aortic dissection involves the ascending aorta and is a surgical emergency with untreated mortality of 1–2% per hour due to risk of aortic rupture, cardiac tamponade, coronary ostium dissection, or severe aortic regurgitation. Urgent open surgical repair with cardiopulmonary bypass (replacement of ascending aorta ± aortic root) is the gold standard. Medical management alone is reserved for uncomplicated Stanford Type B dissections (descending aorta only). TEVAR is the treatment for complicated Type B dissections.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.