Early and late management of type B aortic dissection

Abstract

The management of type B aortic dissection is undergoing profound changes with timely TEVAR accepted as first-line strategy in the setting of complicated dissection; with recent technological advances and in experienced hands this intervention is considered safe and life-saving. With the ability to remodel the dissected aorta as a result of scaffolding even pre-emptive endovascular treatment is being considered and supported by long-term stability and often prevention of aneurysmal expansion. This insight and a growing number of silent risk conditions (resistant hypertension, partial false lumen thrombosis) may lower the threshold for TEVAR in asymptomatic patients in the subacute phase. In the chronic phase of a type B dissection patients are usually free of symptoms, however, with the expanding false lumen at risk of rupture. Advanced TEVAR options (including branches and fenestrations) are likely to be used more often than open surgical replacement of such aneurysmatic segment of the dissected aorta in that chronic phase. All dissection patients should be offered lifelong surveillance.

Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection

“…The need for invasive treatment for uncomplicated DAD is not well established, as early survival rates for chronic DAD patients on medical therapy are acceptable but long‐term outcomes show significant aortic aneurysm formation in 25–50% of patients after 4 years . Chronic DAD may require eventual intervention with either open elephant trunk (ET) repair or TEVAR, which is less invasive …”

Aortic dissection: medical, interventional and surgical management

“…Therefore, patients with partial thrombosis of FL could be considered for this treatment which supports the remodelling of the FL 9. Perioperative mortality after TEVAR is 7%–9% and risk of spinal cord ischaemia is 1.9% 47. During TEVAR, the entry is obliterated by placement of an endovascular stent graft with redirection of the blood flow into the TL.…”

New Paradigms in the Treatment of Acute Complicated and Uncomplicated Type B Aortic Dissection

“…20 These studies, along with additional registry evidence, led the U.S. Food and Drug Administration to approve two endovascular devices for the management of type B dissection in 2014, and many physicians now consider TEVAR to be the optimal choice for the management of acute type B aortic dissection. 21 It should be noted, however, that despite this early excitement, long-term data is limited and TEVAR is not without complications such as paralysis, retrograde type A dissection, rupture and technical limitations. Further studies are needed to determine the true superiority for complicated dissections.…”