Medical therapy is the first line treatment for dissections of the descending thoracic aorta, and is aimed at reducing the mean, peak and diastolic recoil arterial pressure and the dP/dt while maintaining sufficient pressure to adequately perfuse all vital organs. Surgical intervention is warranted for patients with progression of dissection, impending rupture, refractory hypertension, a sizable localized false aneurysmal component, or continued pain.