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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
REVIEWS ALL ABOUT AORTIC DISSECTIONS
Italian Journal of Vascular and Endovascular Surgery 2010 June;17(2):135-9
Strategies for organ malperfusion in acute type B dissections
D’Elia P., Midulla M., Maioli F., O’Brien N., Haulon S.
Vascular Surgery, Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, Lille, France
Acute type B aortic dissections (B AD) are managed medically. Up to one-third of the dissections are complicated by a malperfusion syndrome (visceral, renal, spinal, limb ischemia). Intervention (open surgical or endovascular) is reserved for complicated type B AD. Endovascular treatment includes the placement of a stent-graft into the proximal aorta, branch vessel stenting, uncovered stent placement in the abdominal aorta, and aortic fenestration. Recently, the paradigm of the treatment for these acute complicated dissections has shifted in favor of endovascular therapy over open surgical intervention. Although the evidence base for the roles of various approaches is sparse, data is currently being accumulated and must be analyzed to better estimate both the short and long-term benefits.