Aortic dissection (AD) is a life-threatening acute vascular disease with a complex and not yet fully understood pathogenesis. In recent years, metabolic reprogramming has gradually emerged as a significant factor in the occurrence and development of AD. This review summarizes the abnormal alterations in major metabolic pathways, including amino acid metabolism, glucose metabolism, and lipid metabolism, and their impact on vascular cell functions in AD. Metabolic reprogramming contributes to the progression of AD by regulating the functions of endothelial cells (EC) and vascular smooth muscle cells (VSMC), thereby promoting the destruction of the vascular wall structure and exacerbating inflammatory responses. Additionally, this paper summarizes the potential applications of metabolism-related molecules in the early diagnosis and treatment of AD, emphasizing the importance of metabolic regulation as a novel strategy for AD prevention and management. Finally, future research directions in the study of metabolic reprogramming in AD are proposed, including in-depth mechanistic studies, the development of novel biomarkers, and the optimization of clinical intervention strategies, aiming to provide new insights and methods for the prevention and treatment of AD.