Thoracic aortic dissection is a life-threatening condition that involves a separation between the intimal and medial layers of the aortic wall. The estimated prevalence of aortic dissection in the general population is between 2.0 and 3.5 per 100,000 and carries a risk of significant morbidity and mortality, particularly with involvement of the ascending aorta [1]. Risk factors for aortic dissection commonly include increasing age, hypertension, long-term tobacco use, hyperlipidemia, pre-existing aortic aneurysm, substance use disorder (eg, amphetamines and cocaine), and genetic aortopathy [1]. As the population continues to age, the number of older adults, generally defined as 65 years and older, who experience acute aortic dissection will also increase.

According to the US Census, the population of people older than 65 years grew nearly five times faster than the total population over the past 100 years. In 2020, there were 56 million people within this age group, accounting for nearly 17% of the total population [2]. Both nonoperative and operative intervention for older adults with acute aortic dissection carries increased risk for perioperative complications and reduced long-term survival due to complex comorbidity profile and underlying frailty. However, the introduction and continued evolution of endovascular therapies has expanded treatment options for older patients. We will outline both medical and surgical considerations in the treatment of acute and chronic dissection for this unique patient population.