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Questions and Certainty in Diagnosis and Management of Acute Type B Aortic Dissection

Luigi Lovato1, Maria Adriana Cocozza1, Alessandro Onori2

  • 1Pediatric and Adult Cardiothoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.

Reviews in Cardiovascular Medicine
|March 3, 2025
PubMed

Insights

Type B aortic dissection (TBAD) management is evolving. While computed tomography angiography (CTA) is key for diagnosis, advanced imaging like MRI and PET are for stable patients. Thoracic endovascular aortic repair (TEVAR) offers a minimally invasive option, but its use in uncomplicated TBAD is debated.

Area of Science:

  • Cardiovascular Medicine
  • Medical Imaging
  • Surgical Innovation

Background:

  • Type B aortic dissection (TBAD) is a critical condition demanding prompt diagnosis and intervention.
  • Current management strategies involve complex diagnostic and therapeutic decisions.
  • Controversies persist regarding optimal diagnostic modalities and treatment approaches for TBAD.

Purpose of the Study:

  • To review and analyze the most critical and controversial aspects of contemporary Type B aortic dissection management.
  • To evaluate the role of advanced imaging techniques in TBAD diagnosis and monitoring.
  • To critically assess the current evidence and clinical practice surrounding thoracic endovascular aortic repair (TEVAR) for TBAD.

Main Methods:

  • Comprehensive review of current literature on TBAD diagnosis and treatment.
  • Analysis of the utility of computed tomography angiography (CTA), magnetic resonance imaging (MRI), and positron emission tomography (PET) in TBAD.
  • Evaluation of the evidence for thoracic endovascular aortic repair (TEVAR) versus medical therapy and open surgery for complicated and uncomplicated TBAD.

Main Results:

  • Computed tomography angiography (CTA) is the cornerstone for acute TBAD diagnosis and monitoring.
  • Advanced imaging (MRI, PET) shows potential but is best reserved for stable patients.
  • Thoracic endovascular aortic repair (TEVAR) is a viable option for complicated TBAD, reducing perioperative risks.
  • The role of preemptive TEVAR in uncomplicated TBAD remains controversial, with ongoing debate on long-term outcomes.

Conclusions:

  • Accurate diagnosis using CTA is crucial for timely intervention in acute TBAD.
  • TEVAR represents a significant advancement for complicated TBAD, offering a less invasive approach.
  • Further research is needed to clarify the optimal use of TEVAR in uncomplicated TBAD and its long-term efficacy.

Keywords:
computed tomography angiography (CTA)thoracic endovascular aortic repair (TEVAR)type B aortic dissection (TBAD)

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