REVIEW   

Italian Journal of Vascular and Endovascular Surgery 2018 December;25(4):314-9

DOI: 10.23736/S1824-4777.18.01327-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Acute type B aortic dissection

Maen A. HOSN ¹ ✉, Luigi PASCARELLA ²

¹ Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; ² Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC, USA

Acute aortic dissection is a potentially catastrophic aortic pathology which involves disruption of the intimal layer with subsequent separation of the intima from the media and creation of a false lumen. Although chest or back pain are seen in a majority of patients at presentation, the signs and symptoms of acute aortic dissections vary depending on the origin and extent of the dissection as well as the vessels involved. Stanford type B aortic dissections originate distal to the origin of the left subclavian artery and are usually managed medically with tight blood pressure control and anti-impulse therapy. Surgical intervention, either endovascular or open, is typically reserved for dissection-related complications such as branch vessel malperfusion and aortic dilatation or rupture. Early endovascular stenting of the thoracic aorta and coverage of the intimal tear has been shown to alter flow dynamics and promote early remodeling although this did not translate into improved survival compared to medical therapy alone. Long-term studies on early stenting have suggested delayed disease progression and decreased dissection related mortality but this data is limited.

KEY WORDS: Dissecting aneurysm - Endovascular procedures - Stents - Thoracic aorta