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Novel and Innovative Hybrid Technique for Type A Aortic Dissection

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Type B Aortic Dissection Management: A Narrative Review of Guidelines and Systematic Reviews.

Samir Ghimire¹, Arman Arghami², Aresha Masood Shah³

¹Carribean Medical University, Willemstad, Curacao.

Galen Medical Journal

|October 21, 2024

Summary

Treatment for type B aortic dissection varies. Thoracic endovascular aortic repair (TEVAR) is often best for complex cases, while best medical therapy (BMT) and open surgery (OS) are also options. TEVAR may lower early death but raises stroke risk.

Keywords:

Aortic Dissection Endovascular Repair Meta-analysis Review Systematic Review

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Area of Science:

Cardiovascular Surgery
Vascular Medicine
Thoracic Surgery

Background:

Management of type B aortic dissection (TBAD) with complex presentation or stable hemodynamics remains debated.
This review assesses the safety and effectiveness of various TBAD therapies.

Purpose of the Study:

To review and synthesize evidence on therapeutic approaches for type B aortic dissection.
To evaluate the safety and effectiveness of best medical therapy (BMT), thoracic endovascular aortic repair (TEVAR), and open surgery (OS) for TBAD.

Main Methods:

A systematic search of major online databases (PubMed, Science Direct, Web of Science, Cochrane, Scopus) was conducted.
Relevant systematic reviews, guidelines, and meta-analyses published up to July 2023 were included.
Conclusions from the selected studies were qualitatively synthesized.

Main Results:

TEVAR demonstrated decreased in-hospital mortality compared to open surgery (OS).
TEVAR is recommended for complicated TBAD, with OS as a fallback; however, TEVAR carries an increased early stroke risk.
While BMT reduced early stroke, it was associated with increased late all-cause mortality compared to TEVAR.

Conclusions:

Type B aortic dissection management is complex, influenced by presentation and hemodynamics.
TEVAR is often preferred for complex cases, but BMT and OS remain viable options.
TEVAR may reduce in-hospital mortality but necessitates careful consideration of its associated early stroke risk.