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Gombert A. 1, Thilo Von Trotha K. 1, Jacobs M. J. 1, 2, Grommes J. 1, 3
1 European Vascular Center Aachen-Maastricht, University Hospital RWTH, Aachen, Germany;
2 European Vascular Center Aachen-Maastricht, Medical University Maastricht, The Netherlands;
3 Institute for Cardiovascular Prevention, Ludwig-Maximilians University, Munich, Germany
Acute dissection is still a life-threatening disease. In contrast to Stanford type A aortic dissection, which needs urgent surgical repair, the majority of type B aortic dissection can be successfully treated with effective antihypertensive therapy in the acute phase. However, one- third of patients with type B aortic dissection suffer life-threatening complications, including death, rupture, increasing aortic diameter, and visceral or lower limb ischemia both in the acute and in the long-term phase. Thoracic endovascular therapy (TEVAR) has become the standard therapy in case of acute complicated type B dissection. Open surgical repair in the acute setting is only indicated in selected situations. The medical treatment remains the standard therapy for uncomplicated cases although this therapy does not prevent long-term complications like post dissection aneurysm. Little evidence derived from small prospective randomized trials support that prophylactic TEVAR in uncomplicated type B dissections might improve survival after type B dissection and reduce the risk of aneurysmatic enlargement. Therefore, there is a shift to treat more patients by endovascular means in the acute setting.