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Protocolized management of acute type B aortic dissections reduces disease progression and need for surgery

Leah M Gober1, Kate Telma1, Ethan Richmond2

  • 1Division of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, WI.

Journal of Vascular Surgery
|November 29, 2025
PubMed

Insights

Implementing a standardized protocol for acute type B aortic dissection (TBAD) reduced disease progression and the need for aortic surgery. This approach improves outcomes for patients with TBAD.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Medical Protocols

Background:

  • Treatment for acute type B aortic dissection (TBAD) varies significantly.
  • Optimal medical therapy (OMT) is the current standard of care and control for trials.
  • Standardization of TBAD care is needed.

Purpose of the Study:

  • To assess the impact of an institutional acute aortic protocol on TBAD patient outcomes.
  • To quantify changes in survival, need for surgery, and disease progression post-protocol implementation.

Main Methods:

  • Single-center, retrospective cohort study of 146 patients over 12 years.
  • Compared outcomes before (n=73) and after (n=73) protocol initiation.
  • Analyzed survival, freedom from aortic surgery, and progression to complicated dissection.

Main Results:

  • Post-protocol patients showed improved freedom from aortic surgery (75% vs. 45%).
  • Lower rates of all-cause (22% vs. 42%) and aortic-specific (8% vs. 22%) surgery during admission.
  • Reduced progression to complicated dissection at 72 hours (5% vs. 19%).

Conclusions:

  • A standardized OMT protocol effectively decreased acute TBAD progression.
  • The protocol reduced the 5-year requirement for aortic surgery.
  • Standardized management protocols for TBAD are recommended.
Abstract

Keywords:
Acute type B aortic dissectionOptimal medical therapyStandardized protocol

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