Update in the management of type B aortic dissection

Foeke Jh 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 journalArticle

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)251-63
Number of pages13
JournalVascular Medicine
Volume21
Issue number3
DOIs
Publication statusPublished - Jun 2016

Fingerprint

Dissection
Stents
Rupture
Multimodal Imaging
Transplants
Aortic Rupture
Aortic Diseases
Genetic Testing
Thoracic Aorta
Antihypertensive Agents
Dilatation
Thorax
Heart Rate
Blood Pressure
Survival
Mortality
Wounds and Injuries
Therapeutics

Keywords

  • Journal Article
  • Review

Cite this

Nauta, F. J., Trimarchi, S., Kamman, A. V., Moll, F. L., Van Herwaarden, J. A., Patel, H. J., ... Froehlich, J. B. (2016). Update in the management of type B aortic dissection. Vascular Medicine, 21(3), 251-63. https://doi.org/10.1177/1358863X16642318

Update in the management of type B aortic dissection. / Nauta, Foeke Jh; Trimarchi, Santi; Kamman, Arnoud V; Moll, Frans L.; Van Herwaarden, Joost A.; Patel, Himanshu J.; Figueroa, C. Alberto; Eagle, Kim A.; Froehlich, James B.

In: Vascular Medicine, Vol. 21, No. 3, 06.2016, p. 251-63.

Research output: Contribution to journalArticle

Nauta, FJ, Trimarchi, S, Kamman, AV, Moll, FL, Van Herwaarden, JA, Patel, HJ, Figueroa, CA, Eagle, KA & Froehlich, JB 2016, 'Update in the management of type B aortic dissection', Vascular Medicine, vol. 21, no. 3, pp. 251-63. https://doi.org/10.1177/1358863X16642318
Nauta FJ, Trimarchi S, Kamman AV, Moll FL, Van Herwaarden JA, Patel HJ et al. Update in the management of type B aortic dissection. Vascular Medicine. 2016 Jun;21(3):251-63. https://doi.org/10.1177/1358863X16642318
Nauta, Foeke Jh ; Trimarchi, Santi ; Kamman, Arnoud V ; Moll, Frans L. ; Van Herwaarden, Joost A. ; Patel, Himanshu J. ; Figueroa, C. Alberto ; Eagle, Kim A. ; Froehlich, James B. / Update in the management of type B aortic dissection. In: Vascular Medicine. 2016 ; Vol. 21, No. 3. pp. 251-63.
@article{ba131ecb031c401ca0e5a2296c9748de,
title = "Update in the management of type B aortic dissection",
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.",
keywords = "Journal Article, Review",
author = "Nauta, {Foeke Jh} and Santi Trimarchi and Kamman, {Arnoud V} and Moll, {Frans L.} and {Van Herwaarden}, {Joost A.} and Patel, {Himanshu J.} and Figueroa, {C. Alberto} and Eagle, {Kim A.} and Froehlich, {James B.}",
note = "{\circledC} The Author(s) 2016.",
year = "2016",
month = "6",
doi = "10.1177/1358863X16642318",
language = "English",
volume = "21",
pages = "251--63",
journal = "Vascular Medicine",
issn = "1358-863X",
publisher = "SAGE Publications Ltd",
number = "3",

}

TY - JOUR

T1 - Update in the management of type B aortic dissection

AU - Nauta, Foeke Jh

AU - Trimarchi, Santi

AU - Kamman, Arnoud V

AU - Moll, Frans L.

AU - Van Herwaarden, Joost A.

AU - Patel, Himanshu J.

AU - Figueroa, C. Alberto

AU - Eagle, Kim A.

AU - Froehlich, James B.

N1 - © The Author(s) 2016.

PY - 2016/6

Y1 - 2016/6

N2 - 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.

AB - 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.

KW - Journal Article

KW - Review

U2 - 10.1177/1358863X16642318

DO - 10.1177/1358863X16642318

M3 - Article

C2 - 27067136

VL - 21

SP - 251

EP - 263

JO - Vascular Medicine

JF - Vascular Medicine

SN - 1358-863X

IS - 3

ER -