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[Treatment Strategy for Complicated Acute Type B Aortic Dissection in the Thoracic Endovascular Aortic Repair Era]

Norihisa Karube1, Keiji Uchida, Shinichi Suzuki

  • 1Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|April 22, 2017
PubMed

Insights

Thoracic endovascular aortic repair (TEVAR) is a primary treatment for acute type B aortic dissection (ABAD), especially for rupture or ischemia. TEVAR effectively manages malperfusion and offers rapid, less-invasive repair for complex cases.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Thoracic Surgery

Background:

  • Acute type B aortic dissection (ABAD) presents complex challenges, including rupture, organ malperfusion, and hemodynamic instability.
  • Thoracic endovascular aortic repair (TEVAR) has emerged as a primary therapeutic strategy for complicated ABAD since 2009.

Purpose of the Study:

  • To outline the institutional treatment strategy for complicated acute type B aortic dissection.
  • To detail the indications and application of TEVAR in managing various ABAD presentations, including rupture, malperfusion, and hemodynamic instability.

Main Methods:

  • TEVAR is employed as the first-line therapy for ABAD with rupture or organ ischemia.
  • For ruptured communicating ABAD, TEVAR focuses on sealing proximal entry tears and covering descending aortic hematomas.
  • Treatment for ABAD with malperfusion is tailored based on the type of branch vessel obstruction (dynamic or static).

Main Results:

  • TEVAR is utilized to prevent late aortic events and treat dynamic malperfusion in ABAD patients.
  • TEVAR provides a rapid and less-invasive central repair option for complicated ABAD patients in poor condition or with hemodynamic instability.
  • The strategy emphasizes careful application of TEVAR and its combination with other therapies.

Conclusions:

  • TEVAR is a cornerstone in the management of complicated acute type B aortic dissection.
  • The approach to TEVAR in ABAD requires individualized adaptation based on patient condition and specific disease characteristics.
  • TEVAR offers a versatile and effective solution for complex ABAD, improving outcomes and minimizing invasiveness.

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