Intraoperative aortic intimal intussusception (AII) is an uncommon but life-threatening complication during thoracic endovascular aortic repair (TEVAR). Remedial intervention is difficult, and it is prone to misdiagnosis, underdiagnosis, and misjudgment. Accurately identifying intraoperative AII and promptly providing effective treatment pose a significant challenge. Intraoperative AII is considered a secondary condition, and the specific etiology remains unclear, potentially associated with surgical factors and underlying aortic pathologies. This article, based on relevant literature and clinical experiences, introduces and discusses the causes, classifications, key points in diagnosis and evaluation, and emergency intravascular management of intraoperative AII in patients undergoing TEVAR for aortic dissection. The authors first propose a refined classification based on visceral blood flow perfusion, adding an assessment of the severity of visceral branch ischemia to the existing classification. This new classification divides intraoperative AII into two subtypes (a and b) based on intraoperative DSA depicting visceral branch perfusion. The advantage of the new classification lies in its ability not only to differentiate the severity of visceral ischemia but also to guide endovascular emergency management strategies. Secondly, for patients suspected of intraoperative AII, detailed intraoperative angiography is necessary to determine the classification. The authors recommend a three-step process involving proximal and distal stent graft imaging and endoluminal imaging of the abdominal aortic true lumen. This aids in clarifying the stability of the proximal landing zone and the type of intraoperative AII, determining the poorly perfused visceral branches, severity, and type of ischemic obstruction, and is crucial for the subsequent remedial measures. Finally, intraluminal remedial stenting is preferred for its excellent therapeutic effects, minimal trauma, and rapid postoperative recovery. The procedure should proceed smoothly in a proximal-to-distal and main trunk-to-branch manner. Concerning the reconstruction of blood supply in the distal thoracoabdominal aorta, existing mainstream approaches have certain limitations. The authors recommend a "two-step" approach to rebuild the blood supply of the true lumen of the aorta. This approach can prevent further detachment of the intimal layer toward the distal end.