Although most patients with acute type B aortic dissection are treated medically, emergency surgery is needed for patients with complications, such as rupture, uncontrollable pain, refractory hypertension, a huge pseudo-lumen or organ ischemia. Optimal surgery should be selected according to each condition. An emergent descending aortic replacement is applied mainly for ruptures or impending ruptures, while a surgical bypass, fenestration or thrombectomy is used for visceral organ or leg ischemia. In our data, 9 (23%) out of 40 patients with acute type B aortic dissection underwent emergent surgical treatment. In-hospital mortality was 11.1%. Because it is difficult to diagnose visceral ischemia, patients who might be affected with one must be treated promptly. Although catheter intervention is expected to improve the results of these high-risk patients, more investigation is needed to discover a new therapeutic strategy for acute type B aortic dissection.