ACC/AHA Aortic Disease 2022 — Guideline for the Diagnosis and Management of Aortic Disease

Acute aortic syndromes require immediate anti-impulse therapy. Unless contraindicated, IV beta-blockade is recommended as initial therapy; add a vasodilator when BP remains above target after rate/impulse control. Target systolic BP <120 mmHg or the lowest BP that maintains end-organ perfusion and heart rate 60–80 bpm. Type A aortic dissection requires emergent surgical repair. Uncomplicated Type B dissection is managed with initial medical therapy as the foundational strategy; TEVAR may be considered in selected uncomplicated patients with high-risk anatomical features (e.g., aortic diameter > 40 mm, false-lumen diameter > 20-22 mm, entry tear > 10 mm or on the lesser curvature) via individualized, shared decision-making rather than as an automatic indication. Complicated Type B dissection (rupture, branch-vessel occlusion/malperfusion, extension, progressive enlargement, intractable pain, or uncontrolled hypertension) mandates intervention, generally TEVAR when anatomy is favorable.