A prompt diagnosis is the cornerstone of effective treatment of aortic dissection and it is the single most important determinant of survival in this patient population. New imaging modalities such as transesophageal echocardiography, magnetic resonance imaging, helical computed tomography and electron-beam computed tomography have been introduced during the last decade. These new imaging techniques allow for a better and earlier diagnosis of aortic diseases even in emergency situations. Bearing in mind the high overall mortality of aortic dissection, the role of prevention cannot be overstressed. The main risk factor for aortic dissection/rupture is the aortic diameter; therefore we would like to stress the role of aortic replacement as an effective preventive method for aortic dissection/rupture. Determining the right time for elective surgery, when the operative risk is lower than the risk of dilation-related complications, could contribute to a decrease in urgent surgical procedures on the ascending aorta.