Aortic Dissection: Clinical Presentation, Complications, and Modern Management

Objectives. To summarize current evidence on the pathophysiology, classification, risk factors, clinical presentation, diagnosis, and contemporary medical, surgical, and endovascular management of aortic dissection, with attention to complicated presentations and special clinical settings. Methods. A narrative review was performed. PubMed, Google Scholar, and Scopus were searched without restriction on publication date (last search: June 2026), supplemented by forward and backward citation tracking. Priority was given to publications from 2015 onward, while foundational studies relevant to classification and pathophysiology were retained. The 2022 ACC/AHA, 2024 ESC, and 2024 EACTS/STS guidelines served as the reference framework. A total of 60 sources were included. As this is a narrative review, the number of records identified and screened was not formally recorded. Results. Aortic dissection is a life-threatening vascular emergency characterized by separation of the aortic wall layers and formation of a false lumen, potentially resulting in organ malperfusion, rupture, and death. Important predisposing factors include hypertension and heritable connective-tissue disorders. The usual presentation is sudden, severe chest or back pain; however, painless and atypical presentations may delay diagnosis. Diagnostic work-up combines pretest probability assessment (aortic dissection detection risk score with D-dimer) with CT angiography as the first-line imaging test. Acute type A dissection requires emergency surgery, with the extent of root and arch repair tailored to anatomy and operative risk; in selected stable patients with mesenteric malperfusion, initial reperfusion followed by delayed central repair is an alternative. Thoracic endovascular aortic repair is the first-line treatment for complicated type B dissection and may be considered in uncomplicated cases with high-risk features. Malperfusion syndrome, acute lung injury, and pregnancy-associated dissection adversely affect prognosis. Conclusions. Aortic dissection remains a critical cardiovascular condition requiring prompt recognition and immediate care. Contemporary management is driven by anatomy and complications; long-term blood-pressure control and lifelong imaging surveillance are essential, and early diagnosis remains the main unmet need.