The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection

MacGillivray, Thomas E.; Gleason, Thomas G.; Patel, Himanshu J.; Aldea, Gabriel S.; Bavaria, Joseph E.; Beaver, Thomas M.; Chen, Edward P.; Czerny, Martin; Estrera, Anthony L.; Firestone, Scott; Fischbein, Michael P.; Hughes, G. Chad; Hui, Dawn S.; Kissoon, Kalie; Lawton, Jennifer S.; Pacini, Davide; Reece, T. Brett; Roselli, Eric E.; Stulak, John M.

doi:10.1016/j.athoracsur.2021.11.002

Cited by 84 publications

(73 citation statements)

References 200 publications

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“…Typically, Type A ascending dissections require surgical treatment while Type B descending dissections are initially medically managed 8 , 27 but endovascular repair has become more commonplace, 28 particularly if there is evidence of rupture or malperfusion. 29 Optimized medical management of Type B aortic dissections usually centers around antihypertensive agents, 30 , 31 which alleviate the hemodynamic stress on the damaged aortic wall, but randomized controlled studies to discern treatment options are lacking. 8 In a Type B aortic dissection, a false lumen (the newly created passage for blood) forms.…”

Section: Use Of Nitroglycerin In the Emergency Departmentmentioning

confidence: 99%

Nitroglycerin Use in the Emergency Department: Current Perspectives

Twiner¹,

Hennessy²,

Wein³

et al. 2022

OAEM

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Nitroglycerin, a fast-acting vasodilator, is commonly used as a first-line agent for angina in the emergency department and to manage chest pain due to acute coronary syndromes. It is also a treatment option for other disease states such as acute heart failure, pulmonary edema, and aortic dissection. Nitroglycerin is converted to nitric oxide, a potent vasodilator, in the body, leading to venodilation at lower dosages and arteriodilation at higher dosages that results in both preload and afterload reduction, respectively. Although nitroglycerin has historically been administered as a sublingual tablet and/or spray, it is often given intravenously in the emergency department as this enables titration to effect with predictable pharmacokinetics. In this review article, we outline the indications, mechanism of action, contraindications, and adverse effects of nitroglycerin as well as review relevant literature and make general recommendations regarding the use of nitroglycerin in the emergency department.

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Section: Use Of Nitroglycerin In the Emergency Departmentmentioning

confidence: 99%

Nitroglycerin Use in the Emergency Department: Current Perspectives

Twiner¹,

Hennessy²,

Wein³

et al. 2022

OAEM

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show abstract

“…Standard antihypertensive therapy is often inadequate, which could hypothetically be attributed to the attenuated baroreflex sensitivity in these patients. Consequently, AD can be associated with baroreceptor reflex failure resulting in hypertension and subsequent dysregulation of the blood pressure maintenance [ 60 , 77 ]. Dissection of the aorta might disrupt signal transduction of blood pressure changes, reflected by shear stress transferred across the aortic wall, towards the mechanosensory baroreceptors in the outer layer of the aortic arch.…”

Section: Baroreceptors and Aortic Dissectionmentioning

confidence: 99%

Baroreceptors in the Aortic Arch and Their Potential Role in Aortic Dissection and Aneurysms

Reutersberg

Pelisek

Ouda

et al. 2022

JCM

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The arterial baroreflex is a key autonomic regulator of blood pressure whose dysfunction has been related to several cardiovascular diseases. Changes in blood pressure are sensed by specific mechanosensory proteins, called baroreceptors, particularly located in the outer layer of the carotid sinus and the inner curvature of the aortic arch. The signal is propagated along the afferent nerves to the central nervous system and serves as negative feedback of the heart rate. Despite extensive research, the precise molecular nature of baroreceptors remains elusive. Current knowledge assumes that baroreceptors are ion channels at the nerve endings within the outer layer of the arteries. However, the evidence is based mainly on animal experiments, and the specific types of mechanosensitive receptors responsible for the signal transduction are still unknown. Only a few studies have investigated mechanosensory transmission in the aortic arch. In addition, although aortic dissection, and particularly type A involving the aortic arch, is one of the most life-threatening cardiovascular disorders, there is no knowledge about the impact of aortic dissection on baroreceptor function. In this review, we aim not to highlight the regulation of the heart rate but what mechanical stimuli and what possible ion channels transfer the corresponding signal within the aortic arch, summarizing and updating the current knowledge about baroreceptors, specifically in the aortic arch, and the impact of aortic pathologies on their function.

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“…The standard treatment strategy for Stanford Type B aortic dissection (TBAD) consists of the best possible drug therapy, with the aim of adequate blood pressure control [ 1 , 2 ]. However, the disease can take a complicated course: false lumen rupture or organ malperfusion may occur, both requiring emergency treatment, to avoid a fatal outcome.…”

Section: Introductionmentioning

confidence: 99%

“…However, the disease can take a complicated course: false lumen rupture or organ malperfusion may occur, both requiring emergency treatment, to avoid a fatal outcome. The advances in endovascular therapy in recent decades have led to thoracic endovascular aortic repair (TEVAR) becoming the treatment of choice for complicated TBAD (cTBAD), with lower rates of morbidity and mortality than open repair [ 1 , 2 , 3 , 4 ]. With respect to malperfusion, the visceral segment of the aorta can be involved, leading to ischemia of the liver, the small intestine, and the kidneys.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair (TEVAR) First in Patients with Lower Limb Ischemia in Complicated Type B Aortic Dissection: Clinical Outcome and Morphology

Meisenbacher

Hagedorn

Skrypnik

et al. 2022

JCM

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Acute Type B aortic dissection (TBAD) can cause organ malperfusion, e.g., lower limb ischemia (LLI). Thoracic endovascular aortic repair (TEVAR) represents the standard treatment for complicated TBAD; however, with respect to LLI, data is scant. The aim of this study was to investigate clinical and morphological outcomes in patients with complicated TBAD and LLI managed with a “TEVAR-first” policy. Between March 1997 and December 2021, 731 TEVAR-procedures were performed, including 106 TBAD-cases. Cases with TBAD + LLI were included in this retrospective analysis. Study endpoints were morphological/clinical success of TEVAR, regarding aortic and extremity-related outcome, including extremity-related adjunct procedures (erAP) during a median FU of 28.68 months. A total of 20/106 TBAD-cases (18.8%, 32–82 years, 7 women) presented with acute LLI (12/20 Rutherford class IIb/III). In 15/20 cases, true lumen-collapse (TLC) was present below the aortic bifurcation. In 16/20 cases, TEVAR alone resolved LLI. In the remaining four cases, erAP was necessary. A morphological analysis showed a relation between lower starting point and lesser extent of TLC and TEVAR success. No extremity-related reinterventions and only one major amputation was needed. The data strongly suggest that aTEVAR-first-strategy for treating TBAD with LLI is reasonable. Morphological parameters might be of importance to anticipate the failure of TEVAR alone.

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The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection

Cited by 84 publications

References 200 publications

Nitroglycerin Use in the Emergency Department: Current Perspectives

Nitroglycerin Use in the Emergency Department: Current Perspectives

Baroreceptors in the Aortic Arch and Their Potential Role in Aortic Dissection and Aneurysms

Thoracic Endovascular Aortic Repair (TEVAR) First in Patients with Lower Limb Ischemia in Complicated Type B Aortic Dissection: Clinical Outcome and Morphology

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