INTRODUCTION For the last several decades, initial management of Stanford type B aortic dissections (DeBakey IIIa or IIIb) has involved medical therapy aimed at reducing blood pressure and impulse stress (Dp/dT). This concept has been indoctrinated into the medical field but is now being challenged with advancements in endovascular therapies and devices. Although there have been advances in the medical management and intensive care unit care, medical modalities alone may still pose a 25 -50% complication rate to the patients, resulting in some physicians seeking alternative approaches to reduce this risk in certain subsets of these patients. AREAS COVERED This review will detail the etiology, classification, diagnosis and evolution in treatment of acute type B dissections. We will also review data from recent trials on thoracic endovascular aortic repair and its role in the management of type B aortic dissections to help determine which patients may benefit from placement of a stent graft. Expert commentary: As we see new technologies develop and obtain long-term results with TEVAR, the paradigm of management may shift toward a more aggressive operative approach to improve on the longterm mortality of patients with type B aortic dissections.