Initial stabilization of all acute dissections is identical. Thereafter, type A dissections should be taken for surgery as rapidly as possible while type B dissections should be managed medically unless complications develop. Routine surgery in all patients with type B dissection has not yet been shown conclusively to improve overall mortality except in those with dissections secondary to Marfan's syndrome. Otherwise, surgery is indicated urgently in the presence of distal ischemia or potentially reversible complications. The best treatment for dissections originating in the aortic arch remains controversial. Surgery is difficult and is usually carried out under conditions of circulatory arrest and deep hypothermia; some authorities advocate initial medical treatment unless complications develop. Chronic dissections with evidence of developing complications should be treated in the same way as acute dissections; those with no complications may be treated less aggressively but require urgent control of blood pressure and close observation subsequently.

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Sleep Apnea

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