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Update in the management of aortic dissection

Jip L Tolenaar1, Guido H W van Bogerijen, Kim A Eagle

  • 1Thoracic Aortic Research Center, IRCCS Policlinico San Donato, Cardiovascular Center E. Malan, University of Milan, Via Morandi, 30, 20097, San Donato Milanese, MI, Italy.

Current Treatment Options in Cardiovascular Medicine
|January 12, 2013
PubMed

Insights

Advances in acute aortic dissection (AAD) care improve outcomes. Type A AAD requires surgery, while Type B AAD is medically managed, with thoracic endovascular aortic repair (TEVAR) increasingly used for complicated cases.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Medicine
  • Medical Technology

Background:

  • Acute aortic dissections (AAD) management has evolved with improved diagnosis, peri-operative care, and surgical techniques, leading to reduced mortality and morbidity.
  • The traditional algorithm differentiates Type A AAD (surgical intervention) from Type B AAD (medical management), though initial medical therapy is standard for all AAD.
  • Recent advancements include cerebral protection strategies and aortic valve repair in Type A AAD, and the growing role of thoracic endovascular aortic repair (TEVAR).

Purpose of the Study:

  • To review current management strategies for acute aortic dissections (AAD), focusing on surgical and endovascular interventions.
  • To highlight the evolving role of thoracic endovascular aortic repair (TEVAR) in both Type A and Type B aortic dissections.
  • To emphasize the importance of long-term medical management and surveillance for all AAD patients.

Main Methods:

  • Review of current literature and treatment algorithms for acute aortic dissections.
  • Discussion of surgical techniques for Type A AAD, including cerebral protection and valve repair.
  • Analysis of the application of thoracic endovascular aortic repair (TEVAR) in complicated Type B AAD and potential future uses in Type A AAD.

Main Results:

  • Improved surgical techniques and peri-operative care have decreased mortality and morbidity in AAD.
  • TEVAR is the primary treatment for complicated Type B AAD, effectively managing malperfusion and promoting aortic remodeling.
  • Hybrid procedures combining open repair and TEVAR are used for Type A AAD involving the descending aorta, with potential for future total endovascular repair.

Conclusions:

  • Management of AAD has significantly improved, with specialized surgical techniques for Type A and TEVAR for complicated Type B dissections.
  • TEVAR is a crucial tool for complicated Type B AAD and shows promise for Type A AAD, potentially enabling total endovascular repair in the future.
  • All patients with AAD require lifelong antihypertensive management, imaging surveillance, and clinical follow-up, regardless of initial treatment modality.
Abstract

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