Diagnosis and treatment of uncomplicated type B aortic dissection

Vasc Med. 2016 Dec;21(6):547-552. doi: 10.1177/1358863X16643601. Epub 2016 Apr 28.

Abstract

A type B dissection involves the aorta distal to the subclavian artery, and accounts for 25-40% of aortic dissections. Approximately 75% of these are uncomplicated with no malperfusion or ischemia. Multiple consensus statements recommend thoracic endovascular aortic repair (TEVAR) as the treatment of choice for acute complicated type B aortic dissections, while uncomplicated type B dissections are traditionally treated with medical management alone, including strict blood pressure control, as open repairs have a prohibitively high morbidity of up to 31%. However, with medical treatment alone, the morbidity, including aneurysm degeneration of the affected segment, is 30%, and mortality is 10% over 5 years. For both chronic and acute uncomplicated type B aortic dissections, emerging evidence supports the use of both best medical therapy and TEVAR. This paper reviews the current diagnosis and treatment of uncomplicated type B aortic dissections.

Keywords: aorta; aortic diseases; best medical therapy; thoracic endovascular aortic repair (TEVAR); type B aortic dissection.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Algorithms
  • Aortic Aneurysm, Thoracic / diagnostic imaging*
  • Aortic Aneurysm, Thoracic / history
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / therapy*
  • Aortic Dissection / diagnostic imaging*
  • Aortic Dissection / history
  • Aortic Dissection / mortality
  • Aortic Dissection / therapy*
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / history
  • Blood Vessel Prosthesis Implantation* / mortality
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / history
  • Cardiovascular Agents / therapeutic use*
  • Critical Pathways
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / history
  • Endovascular Procedures* / mortality
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Predictive Value of Tests
  • Risk Factors
  • Treatment Outcome

Substances

  • Cardiovascular Agents