Acute aortic syndrome (Ciurica et al., Hypertension 73:951–960, 2019) comprises a group of potentially catastrophic aortic pathologies that need to be recognized and understood by modern vascular surgeons. The more modern nuances of approach to the diagnosis, classification and management of AAS are outlined, including various classification systems, and underlying pathological processes of the disease. A brief overview of medical management strategies for AAS is offered.