[Treatment of acute aortic dissection type B]

Area of Science:

• Cardiovascular Surgery
• Vascular Medicine
• Interventional Cardiology

Background:

• Acute type B aortic dissection (TBAD) management strategies are evolving.
• Medical management is the primary approach for uncomplicated TBAD.
• Complicated TBAD necessitates timely and effective interventions.

Observation:

• Four patients with acute type B aortic dissection were initially managed medically.
• Three out of four patients required subsequent invasive procedures due to disease progression or complications.
• Interventions included spinal catheter placement for neurological symptoms, endovascular fenestration and stenting for renal artery ischemia, and endograft placement for aortic arch tear and renal artery stenosis.

Findings:

• While medical management is the first line for uncomplicated TBAD, complex presentations often demand advanced interventions.
• Endovascular techniques, including fenestration and stenting, demonstrated utility in addressing specific complications like renal artery compromise.
• Endograft placement proved effective in sealing aortic wall defects and managing associated stenosis.

Implications:

• This case series highlights the critical role of invasive endovascular strategies in managing complicated type B aortic dissections.
• Successful outcomes underscore the potential of tailored endovascular solutions to improve patient prognosis in challenging TBAD cases.
• Further research into optimizing endovascular approaches for complicated TBAD is warranted to refine treatment algorithms.