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Management of complicated and uncomplicated acute type B dissection. A systematic review and meta-analysis

Konstantinos G Moulakakis1, Spyridon N Mylonas1, Ilias Dalainas1

  • 11 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece.

Annals of Cardiothoracic Surgery
|June 27, 2014
PubMed

Insights

For acute complicated type B aortic dissection, endovascular repair offers better survival than open surgery. Conservative management is effective for uncomplicated cases, but more research is needed on long-term outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Acute type B aortic dissection management poses significant clinical challenges.
  • A systematic review and meta-analysis were conducted to evaluate treatment options.

Purpose of the Study:

  • To systematically review and meta-analyze medical, surgical, and endovascular treatments for acute type B aortic dissection.
  • To compare the efficacy and safety of different treatment modalities.

Main Methods:

  • An extensive literature search was performed on databases from January 2006 to November 2013.
  • Studies with fewer than 15 patients were excluded from the meta-analysis.

Main Results:

  • For acute complicated type B dissection, thoracic endovascular aortic repair (TEVAR) had a 7.3% mortality rate versus 19.0% for open repair.
  • Conservative management for acute uncomplicated type B dissection showed a 2.4% mortality rate.
  • TEVAR demonstrated lower rates of cerebrovascular events and spinal cord ischemia (SCI) compared to open repair in complicated cases.

Conclusions:

  • TEVAR offers superior short-term survival for acute complicated type B aortic dissection compared to open surgery.
  • Open repair remains crucial for cases unsuitable for TEVAR, with ongoing durability concerns for endovascular techniques.
  • TEVAR shows promise for aortic remodeling and survival compared to medical therapy alone; further RCTs are needed for uncomplicated dissections.
Abstract

Keywords:
Type B aortic dissectionacuteendovascularmedical treatment

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