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Type B aortic dissections: treating the many to benefit the few?
Dittmar Böckler1, Alexander Hyhlik-Dürr, Maani Hakimi
1Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Germany. dittmar.boeckler@med.uniheidelberg.de
Summary
Endovascular repair for type B aortic dissections has considerable complication and mortality rates. Asymptomatic patients currently benefit more from conservative treatment than stent-grafting.
Area of Science:
- Vascular Surgery
- Cardiovascular Interventions
- Thoracic Aortic Disease
Background:
- Type B aortic dissections can be treated with less invasive stent-grafts.
- Recent studies suggest conservative management for chronic dissections due to low complication rates.
- This study evaluates the shift towards endovascular repair for acute and non-complex type B dissections.
Purpose of the Study:
- To analyze institutional experience with endovascular repair for type B aortic dissections.
- To determine if stent-graft availability has led to a more aggressive endovascular approach.
- To identify optimal patient selection for endovascular versus conservative treatment.
Main Methods:
- Retrospective analysis of 172 patients with type B aortic dissections (1997-2008).
- 118 patients received conservative treatment; 54 underwent endovascular repair.
- Follow-up included computed tomographic angiography.
Main Results:
- Successful stent-graft deployment in 93% of cases; 19% perioperative complications, 11% 30-day mortality.
- Mean follow-up of 32.1 months; overall mortality 18.5%.
- False lumen thrombosis in 60%, aortic expansion in 31%; no survival difference between acute and chronic dissections.
Conclusions:
- Endovascular therapy for type B aortic dissections carries significant complication and mortality risks.
- Stent-grafting is currently indicated for symptomatic patients or those with chronic aneurysmal expansion.
- Asymptomatic patients are best managed conservatively at this stage of stent-graft technology.
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