THE MANAGEMENT OF THORACIC DISSECTIONS 

The Journal of Cardiovascular Surgery 2011 August;52(4):519-27

Copyright © 2011 EDIZIONI MINERVA MEDICA

lingua: Inglese

Uncomplicated type B dissection: are there any indications for early intervention?

De Rango P. ¹, Estrera A. L. ² ✉

¹ Vascular Endovascular Surgery, Hospital S. M. Misericordia, University of Perugia, Perugia, Italy; ² Cardiothoracic and Vascular Surgery, University of Texas Medical School Houston, Memorial Hermann Heart and Vascular Institute, Houston, TX, USA

Currently thoracic endovascular repair (TEVAR) has a limited role in uncomplicated type B aortic dissection. Aggressive medical therapy is deemed appropriate for most of these patients allowing one-year survival rate of 80-90%. Outcomes are less than optimal in the long term, however, since aorta related complications (disease progression, rapid deterioration, acute rupture and elevated mortality) may occur in up to 50% of patients at five years. Subgroups of patients with uncomplicated type B dissection may benefit from early stent-graft placement, but identification of these remains difficult. Only future studies, especially randomized trials, will clarify the utility of early TEVAR in the setting of uncomplicated acute type B dissection.