REVIEW   

Italian Journal of Vascular and Endovascular Surgery 2017 September;24(3):118-26

DOI: 10.23736/S1824-4777.17.01297-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

New developments in the treatment of type B aortic dissection

Andreas MITSIS, Xun YUAN, Esther CAMBRONERO-CORTINAS, Christoph A. NIENABER ✉

Cardiology and Aortic Center, Royal Brompton and Harefield NHS Trust, Imperial College, London, UK

Aortic dissection is an uncommon but a highly lethal condition. The management of type B dissection remains a clinical challenge with a variety of options. Thoracic endovascular aortic repair (TEVAR), aiming for true lumen reconstruction is a well-established treatment of choice for complicated type B aortic dissection. In so-called uncomplicated acute type B aortic dissection, the total diameter of the descending aorta (>45 mm), the large entry in a proximal site, any early expansion of the false lumen, evidence of partial thrombosis of the false lumen, probably a correlate of inflammation on position emission tomography (PET) scanning and high-volume flow in the false lumen on four-dimensional magnetic resonance imaging (4D MRI) are independent high-risk prognostic factors for aortic events; presence of any of these features identify a given clinically asymptomatic patient at high risk. Thus, these patients with high-risk features of type B aortic dissection should be considered for prophylactic and pre-emptive intervention with TEVAR within a 3-month window of “plasticity.” Patients without those high-risk features need very close surveillance and treatment as soon as high-risk criteria are identified during follow-up.

KEY WORDS: Aortic aneurysm - Risk assessment - Vascular grafting - Thrombosis