REVIEWS   

Italian Journal of Vascular and Endovascular Surgery 2015 September;22(3):141-5

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Treatment of acute aortic type B dissection

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.