Update in the management of type B aortic dissection

Foeke J H Nauta, Santi Trimarchi, Arnoud V. Kamman, Frans L. Moll, Joost A. Van Herwaarden, Himanshu J. Patel, C. Alberto Figueroa, Kim A. Eagle, James B. Froehlich

Research output: Contribution to journalArticlepeer-review

Abstract

Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature.

Original languageEnglish
Pages (from-to)251-263
Number of pages13
JournalVascular Medicine
Volume21
Issue number3
DOIs
Publication statusPublished - 2015

Keywords

  • IRAD
  • management
  • optimal medical treatment
  • surgery
  • TEVAR
  • type B aortic dissection (TBAD)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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