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Potentially life-threatening condition in which disruption or aortic intima allows dissection of blood into vessel wall; may involve ascending aorta (type II), descending aorta (type III), or both (type I) (Fig. 125-1). Alternative classification: Type A—dissection involves ascending aorta; type B—limited to transverse and/or descending aorta. Involvement of the ascending aorta is most lethal form. Variant acute aortic syndromes include intramural hematoma without an intimal flap, and penetrating atherosclerotic ulcer.