Purpose of review <p>Chronic type B aortic dissection (cTBAD) remains a significant clinical challenge and continues to evolve. This review highlights current management strategies for cTBAD.</p> Recent findings <p>Nearly 60% of all patients with cTBAD progress to aneurysmal degeneration regardless of optimization of impulse therapy. Patients with aneurysms 5.5 cm or larger remain at high risk for aortic-related mortality. Therefore, open thoracoabdominal aortic aneurysm repair or branched/fenestrated endograft placement is recommended in these patients to prevent rupture.</p> Summary <p>Regardless of the approach, surgical intervention for cTBAD aneurysms is technically challenging with a high risk of one or more significant complications. While considered the gold standard, open surgery carries a high risk of mortality. Endovascular repair has been associated with improved perioperative outcomes but carries a high risk of re-intervention.</p>