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Evidence for and risks of endovascular treatment of asymptomatic acute type B aortic dissection

Rachel E Clough1, Christoph A Nienaber2

  • 1Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK - rachel.clough@kcl.ac.uk.

The Journal of Cardiovascular Surgery
|January 4, 2017
PubMed

Insights

Acute aortic dissection management involves blood pressure control and considering endovascular repair for complications. Early detection and treatment in the subacute phase may improve long-term outcomes for Type B aortic dissection patients.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Diagnostic Imaging

Background:

  • Acute aortic dissection, particularly Type B, presents management challenges.
  • Traditional temporal classification (acute/chronic) now includes a subacute phase.
  • Computed tomography (CT) is the primary diagnostic and management imaging modality.

Purpose of the Study:

  • To review the management strategies for acute Type B aortic dissection.
  • To discuss the outcomes of medical management versus endovascular repair.
  • To highlight the potential benefits of early detection and intervention in the subacute phase.

Main Methods:

  • Review of current literature and clinical practices for Type B aortic dissection.
  • Analysis of outcomes associated with medical management and endovascular repair.
  • Discussion of advanced imaging techniques for early complication detection.

Main Results:

  • Medical management of uncomplicated acute Type B aortic dissection has acceptable in-hospital survival (up to 90%).
  • Long-term survival is significantly lower (up to 50% mortality by 5 years), often due to aortic rupture.
  • Endovascular repair aims for remodeling and thrombosis, showing good long-term results but carries risks like stroke and death.

Conclusions:

  • Active blood pressure management, including beta-blockade, is crucial for acute aortic dissection.
  • Endovascular repair is effective for complications but has associated risks.
  • Intensified early imaging and elective subacute phase treatment are advocated by some experts to improve outcomes.

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