Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Dec;90(12):2425-2433.
doi: 10.1111/ans.16270. Epub 2020 Sep 6.

Management of acute type B aortic dissection

Bijit Munshi  1   2   3   4 , Jens C Ritter  4 , Barry J Doyle  1   5 , Paul E Norman  1   2   3   4
Affiliations
Review

Management of acute type B aortic dissection

Bijit Munshi et al. ANZ J Surg. 2020 Dec.

Abstract

Background: The best management of acute uncomplicated type B aortic dissection is currently a controversial area. Recent advances in endovascular intervention have begun to establish pre-emptive thoracic endovascular aortic repair as a potential strategy. A review about the management for type B aortic dissection has been conducted.

Methods: A narrative review consisting of 157 original articles, meta-analyses and guidelines was conducted. The findings were synthesized and summarized using 70 articles.

Results: There are clear guidelines directing surgical management of acute complicated type B aortic dissection. However, the best management of acute uncomplicated disease is more ambiguous, which is especially concerning in a condition which is associated with significant morbidity and mortality. Medical management alone is generally favoured. Endovascular intervention is now being considered by some surgeons, but it can be technically difficult, while exposing the patient to potential surgical risks.

Conclusions: Clinical and anatomical risk factors have been identified to help vascular surgeons make decisions about treatment in acute uncomplicated type B aortic dissection. New endovascular strategies are being developed to reduce surgical risk and address technical challenges. Registry data should be used to support future best management.

Keywords: aneurysm; dissecting endovascular procedure; risk.

PubMed Disclaimer

References

    1. Coady MA, Rizzo JA, Goldstein LJ. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. Cardiol. Clin. 1999; 17: 615-35; vii.
    1. Tsai TT, Fattori R, Trimarchi S et al. Long-term survival in patients presenting with type B acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. Circulation 2006; 114: 2226-31.
    1. Rylski B, Pérez M, Beyersdorf F et al. Acute non-A non-B aortic dissection: incidence, treatment and outcome. Eur. J. Cardiothorac. Surg. 2017; 52: 1111-7.
    1. Czerny M, Schmidli J, Adler S et al. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur. J. Cardiothorac. Surg. 2019; 55: 133-62.
    1. Riambau V, Böckler D, Brunkwall J et al. Editor's choice - management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur. J. Vasc. Endovasc. Surg. 2017; 53: 4-52.

Publication types

LinkOut - more resources