1. Presents with chest or back pain, may be stroke if proximal enough
2. Thrombolysis is dangerous in this setting
3. Syphilis is a classic etiology that is currently likely overrated,but other causes are Marfan's or atherosclerosis
4. Also consider with unstable vital signs, hypotension, unequal pulses, or widened aortic silhouette on chest x ray
5. Surgical treatment (replacement of the aorta) is performed but the results are poor overall.
6. Warfarin is used but some believe it can lead to cholesterol embolization and purple toe syndrome
7. Antiplatelet agents might be the best treatment although that is not proved.
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