The epidemiological data and reports on long-term predictors of mortality after medically or endovascularly and medically treated patients with acute type B aortic dissection (AD) are scarce. Patients with type B AD between 2000 and 2004 were identified through the inpatient endovascular or autopsy registry at Malmö-Lund University Hospital, Sweden. Seventy-two patients had acute type B AD, of whom eight were found at autopsy. Shock due to ruptured type B AD was associated with in-hospital mortality (P = 0.006) in the 64 eligible patients. Renal insufficiency (odds ratio [OR] = 4.7, 95% confidence interval [CI] 1.1-19.4) and coexistent aortic disease (OR = 4.1, 95% CI 1.0-16.9) remained as independent predictors for long-term mortality after multivariate logistic regression analysis. Endovascular intervention (n = 32) was associated with neither short- nor long-term mortality. The estimated overall incidence of acute type B AD was 2.1/100,000 person-years, and the highest incidence rates were found in men aged 65-74 years (14.6/100,000 person-years) and women aged 75-84 years (19.0/100,000 person-years). Survival in patients with complicated acute type B AD managed with the endovascular technique was the same as in uncomplicated medically treated patients. Renal insufficiency and coexistent aortic disease were strong predictors for long-term mortality.