The most important decision for the patient's prognosis is whether we choose medical treatment or surgical therapy for the management of acute aortic dissection Stanford type B. Recent studies have reported outstanding initial success with entry closure by thoracic endovascular aortic repair( TEVAR) in the patients with Stanford type B aortic dissection. For acute aortic dissection Stanford type B with fatal complications, TEVAR is becoming the first-line therapy. Moreover, the efficacy of endovascular repair for the uncomplicated acute type B aortic dissection, in comparison with standard medical therapy, has been confirmed in some trials. In this report, we demonstrate a trend regarding surgical and endovascular treatment in addition to guidelines for the diagnosis and treatment of aortic aneurysm and aortic dissection (The Japanese Circulation Society 2011).