Objective To summarize the clinical characteristics and treatment options of Stanford type B aortic dissection(AD) in the elderly patients. Methods The clinical data of 55 elderly patients diagnosed with Stanford type B AD in our department from July 2012 to July 2016 were collected. The 19 patients (medication group) with simple Stanford type B aortic dissection were treated with medication, and the other 36 patients (endovascular treatment group) with complicated type were given endovascular surgery plus medication. A statistical analysis was conducted on their age, gender, on-set season, diagnostic duration, clinical manifestations, hypertension grades, and imaging findings. The prognoses of patients with different treatment options were analyzed. SPSS statistics 21.0 was employed for data analysis. And Student’s t test, Chi-square test or rank sum test was employed for comparison for different data between the 2 groups. Results Among the 55 patients, the most common on-set season was spring and winter, accounting for 74.6%(41 patients). There was a significant difference in the age between the medication and endovascular treatment groups [(70.68±6.84) vs (66.75±5.33)years, P=0.022]. But no differences were seen in the gender, diagnostic duration, clinical manifestations, hypertension grades, and imaging findings between the 2 groups (P>0.05). Fifty-three patients (96.4%, 53/55) were followed up for a mean period of 11.2 months, and 2 patients were lost. The rate of symptom relief was significantly lower in the medication group than the endovascular treatment group (68.4% vs 94.4%, P<0.05). No differences were seen in the incidence of complications and mortality rate between the 2 groups (P>0.05). In the medication group, 3 patients were re-hospitalized due to chest pain in 1 to 3 months after discharge, and CT angiography indicated the progressive increase of the dissection, so endovascular surgery was carried out. The re-operation rate was slightly greater in the medication group than the endovascular treatment group, though without obvious difference (P>0.05). Conclusion For the elderly patients, Stanford type B AD is common in spring and winter, and with varied and atypical symptoms. So, great attention should be paid to the disease. Endovascular treatment is still its main treatment.