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Management of acute type B aortic dissections.
Vikalp Jain1, Mark A Farber1, Raghuveer Vallabhaneni1
1a Department of Surgery, Division of Vascular Surgery , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , NC , USA.
Expert Review of Cardiovascular Therapy
|June 25, 2016
Summary
Medical management for Stanford type B aortic dissections has a high complication rate. Thoracic endovascular aortic repair (TEVAR) offers a potential alternative, possibly shifting treatment paradigms toward more aggressive surgical approaches for improved long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Medical Technology
Background:
- Stanford type B aortic dissections (DeBakey IIIa/IIIb) traditionally managed with medical therapy targeting blood pressure and impulse stress.
- Medical management alone carries a 25-50% complication rate despite advances in critical care.
- Emerging endovascular therapies challenge the established medical management paradigm.
Purpose of the Study:
- To review the etiology, classification, diagnosis, and treatment evolution of acute type B aortic dissections.
- To evaluate recent trial data on thoracic endovascular aortic repair (TEVAR) for type B dissections.
- To identify patient subsets who may benefit from stent graft placement.
Main Methods:
- Literature review of acute type B aortic dissections.
- Analysis of recent clinical trials on thoracic endovascular aortic repair (TEVAR).
- Expert commentary on the evolving treatment landscape.
Main Results:
- Medical management of type B aortic dissections has significant associated risks.
- TEVAR is an advancing endovascular option for managing type B aortic dissections.
- Long-term data on TEVAR is crucial for refining treatment strategies.
Conclusions:
- The established medical management of type B aortic dissections is being re-evaluated.
- TEVAR presents a promising alternative for specific patient groups.
- Future treatment paradigms may favor more aggressive operative approaches, including TEVAR, to reduce long-term mortality.
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