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Page 4 of 19 Rinaldi et al. Vessel Plus 2024;8:21 https://dx.doi.org/10.20517/2574-1209.2023.65

Table 1. SVS/STS chronicity classification for AD [16]
Chronicity classification Time from symptoms onset
Hyperacute < 24 h
Acute 1-14 days
Subacute 15-90 days
Chronic > 90 days

Table 2. The TEM classification of AD [17]

T - type A Involvement of the ascending aorta with or without extension into the aortic arch and the descending aorta
B Involvement of the descending aorta without extension into the aortic arch or the ascending aorta
non-A-non- Involvement of the aortic arch with or without extension into the descending aorta, and without extension into
B the ascending aorta
E - entry E0 No detectable entry tear
E1 Entry tear in the ascending aorta
E2 Entry tear between the innominate artery (proximal edge) and the left subclavian artery (LSA) (distal edge)
E3 Entry tear distal to the LSA
M - M0 No malperfusion
malperfusion* M1 Dissection of at least one main coronary artery
M2 Dissection of at least one supra-aortic vessel
M3 Dissection of at least one visceral, renal or iliac vessel
*Malperfusion is also described with plus (+) or minus (-): (+) if the malperfusion is associated with clinical symptoms, and (-) if it is not.

Table 3. SVS/STS acuity classification for AD [16]
Uncomplicated No rupture
No malperfusion
No high-risk features
High-risk Refractory pain
Refractory hypertension
Bloody pleural effusion
Aortic diameter > 40 mm
Radiographic only malperfusion
Readmission
Entry tear: lesser curve location
False lumen diameter > 22 mm
Complicated Rupture
Malperfusion

In this dynamic and evolving landscape, the primary goals of treatment for patients with aTBAD are to
ensure or restore organ perfusion and prevent aortic rupture. The consensus is that patients with
uncomplicated aTBAD can be managed conservatively, while those with complicated aTBAD require
immediate non-conservative interventions. However, the issue of whether to pursue invasive preventive
treatment for uncomplicated patients deemed “high risk” to mitigate the potential for late complications
remains a subject of debate. Different perspectives exist on this matter within the medical community.

MANAGEMENT
Medical management for patients with aTBAD focuses on pain relief and reducing systolic blood pressure