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Review
. 2014 Dec 1;2(6):265-78.
doi: 10.12945/j.aorta.2014.14-040. eCollection 2014 Dec.

Type B Aortic Dissection: A Review of Prognostic Factors and Meta-analysis of Treatment Options

Thomas Luebke  1 , Jan Brunkwall  1
Affiliations
Review

Type B Aortic Dissection: A Review of Prognostic Factors and Meta-analysis of Treatment Options

Thomas Luebke et al. Aorta (Stamford). .

Abstract

According to international guidelines, stable patients with uncomplicated Type B aortic dissection (TBAD) should receive optimal medical treatment. Despite adequate antihypertensive therapy, the long-term prognosis of these patients is characterized by a significant aortic aneurysm formation in 25-30% within four years, and survival rates from 50 to 80% at five years and 30 to 60% at 10 years. In a prospective randomized trial, preemptive thoracic endovascular aortic repair (TEVAR) in patients with chronic uncomplicated TBAD was associated with an excess early mortality (due to periprocedural hazards), but the procedure showed its benefit in prevention of aortic-specific mortality at five years of follow-up. However, preemptive TEVAR may not be the treatment of choice in all patients with uncomplicated TBAD because of the inherent periprocedural complications like stroke, paraparesis, and death, as well as stent graft-induced complications (i.e., retrograde dissection or endoleaks). Thus, the TEVAR-related deaths and complications (especially paraplegia and stroke) raise concerns that moderate the better survival with TEVAR at five years. By timely identification of those patients prone for developing complications, early intervention, preferably in the subacute or early chronic phase, may improve the overall long-term outcome for these patients. Therefore, early detectable and reliable prognostic factors for adverse events are essential to stratify patients who can be treated medically and those who will benefit from rigorous follow-up and, in the long-term, from timely, or even prophylactic, TEVAR. Several studies have identified prognostic factors in TBAD such as aortic diameter, partial false lumen thrombosis, false lumen thickness, and location of the primary entry tear. Combining these clinical and radiological predictors may be essential to implement a patient-specific approach designed to intervene only in those patients who are at high risk of developing complications to improve the long-term outcomes of patients with uncomplicated Type B aortic dissection.

Keywords: Endovascular; Thoracic aorta; Type B aortic dissection.

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Figures

Figure 1.
Figure 1.
Cumulative 30-day all-cause mortality, mixed acute Type B aortic dissection (TBAD).
Figure 2.
Figure 2.
Cumulative 30-day all-cause mortality, chronic Type B aortic dissection (TBAD), mostly uncomplicated.
Figure 3.
Figure 3.
Five-year all-cause mortality, chronic uncomplicated Type B aortic dissection (TBAD).
Figure 4.
Figure 4.
Five year aorta-related mortality, chronic uncomplicated Type B aortic dissection (TBAD).
Figure 5.
Figure 5.
Paraplegia or paraparesis, chronic uncomplicated Type B aortic dissection (TBAD).
Figure 6.
Figure 6.
Stroke, chronic uncomplicated Type B aortic dissection (TBAD).
Figure 7.
Figure 7.
Remodeling rate, chronic uncomplicated Type B aortic dissection (TBAD).
See this image and copyright information in PMC

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