Thoracoabdominal endaortectomy in case of type B aortic dissection

Despite remarkable progress in both, diagnostic and therapeutic development in treating aortic dissections, this continues to be one of the most severe vascular disorders and is subject to high mortality rates. While aortic dissections of Type A can be treated surgically today, in the majority of patients with Type B dissections hypotensive treatment is the method of choice, providing a better chance of survival and the effective prevention of aneurysm formation and rupture at the site of the intimal tear. However in certain cases, Type B dissection generates either isthmic aneurysm formation, or, with distal progression, may result in long segmental thoracic, thoraco-abdominal or abdominal deterioration of the aorta and its side branches. The spinal, visceral, renal and lower limb ischemia threatens the viability of these organs and hypotensive medication may enhance this risk. Emergency diagnostic work-up and selective surgical reconstruction could lead to reduced mortality. In our department we have undertaken 33 thoracoabdominal endoaortectomies with meticulous reconstruction of renal and visceral orifices. The mortality rate in this subgroup of patients was 6%. Based on our experience with Type B aortic dissections we recommend open "endoaortectomy" in selected cases in order to improve the long-term outcome.