A 70-year-old woman presents with sudden onset severe tearing chest pain radiating to the back. BP is 180/100 mmHg in the right arm and 155/90 mmHg in the left. CXR shows a widened mediastinum. CT aortogram confirms a Type A aortic dissection (Stanford classification). Appropriate management is:
- A Emergency endovascular stent grafting (TEVAR)
- B Medical management with IV labetalol and observation
- C Emergency open surgical repair of the ascending aorta ✓
- D Emergency coronary angiography to exclude concurrent MI
Correct answer: C. Emergency open surgical repair of the ascending aorta
Explanation
Stanford Type A aortic dissection (involving the ascending aorta) carries a mortality of approximately 1–2% per hour without surgery and is a surgical emergency requiring open repair under cardiopulmonary bypass. Medical management (BP control) alone is reserved for Type B dissections (not involving ascending aorta) without complications. TEVAR is used for Type B dissections or selected Type A in non-surgical candidates. The blood pressure difference between arms reflects subclavian involvement, not coronary dissection.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.