Purpose of review: Type B aortic dissection has largely been regarded as the nice dissection with regard to its natural course, especially when compared with type A aortic dissection. However, a more thorough look into the natural course of the disease has shown that a high number of patients with type B aortic dissection will experience complications and will require therapy, sooner or later.
Recent findings: Reasons and timepoints are different, being malperfusion, contained rupture and retrograde propagation of the disease into the aortic arch or into the ascending aorta in the early phase and being mainly aneurysmal formation in the chronic phase of the disease.
Summary: This article provides the interested reader with detailed knowledge regarding the natural course of the disease and is meant as a companion to anticipate the right timepoint for therapy and finally as a guide to do the right things when advancing to treatment.