scholarly journals Management of Uncomplicated Type B Aortic Dissection

Hearts ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 14-24
Author(s):  
Xun Yuan ◽  
Rachel E. Clough ◽  
Christoph A. Nienaber
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Term Survival ◽  
Subacute Phase ◽  
Stent Grafting ◽  
Best Medical Treatment ◽  
Type B Dissection ◽  
Acute Dissection

Acute aortic dissection has an incidence of approximately half that of symptomatic abdominal and thoracic aneurysm of the aorta and more than twice the mortality of population-based controls. While urgent undelayed open surgery is the strategy of choice in proximal dissection, medical management has been the mainstay of treatment for uncomplicated distal or type B aortic dissection, but endovascular intervention is now considered a potential treatment option for all type B dissection due to its success in complicated cases. Endovascular repair can be technically demanding in aortic dissection, and timing of the repair can have a significant influence on anatomical and clinical outcome. Observational reports of feasibility and reasonable safety are flanked by only two randomised trials; the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial demonstrated improved remodelling in acute dissection and the INvestigation of STEnt grafts in patients with type B Aortic Dissections (INSTEAD) trial showed better long-term survival in patients treated endovascularly in the subacute phase. Meta-analyses and other large clinical studies have demonstrated mixed results. Due to some risks associated endovascular repair and the requirement of specialist aortic care (which is not always available), a pragmatic approach for current management could involve high intensity serial imaging in the acute phase of a type B aortic dissection, thereby identifying complicated cases for early intervention and selection of patients at high risk of disease progression for deferred endovascular management in the subacute phase within 90 days.

scholarly journals Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database

2017 ◽  
Vol 65 (4) ◽  
pp. 964-971.e3 ◽  
Author(s):  
Arnoud V. Kamman ◽  
Jan Brunkwall ◽  
Eric L. Verhoeven ◽  
Robin H. Heijmen ◽  
Santi Trimarchi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Medical Treatment ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Best Medical Treatment ◽  
Acute Dissection

scholarly journals Management of Acute Uncomplicated Stanford B Aortic Dissection in The Era of Endovascular Repair: A Case Report

2020 ◽  
Vol 1 (3) ◽  
pp. 36-40
Author(s):  
Putri Annisa Kamila ◽  
Novi Kurnianingsih ◽  
Sasmojo Widito ◽  
Djanggan Sargowo ◽  
Budi Satrijo
Keyword(s):  
Aortic Dissection ◽  
Femoral Artery ◽  
Endovascular Repair ◽  
False Lumen ◽  
Long Term Results ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Medication Therapy ◽  
Type B Dissection ◽  
Stanford B

Introduction: Uncomplicated type B aortic dissections have been traditionally treated with medication therapy. While it may provide good short-term results, longterm prognosis may be less favorable. With improvements in endovascular repair and the potential risk of disease progression, thoracic endovascular aortic repair (TEVAR) has been considered inpatients with uncomplicated type B aortic dissection. We present the case of 78-year-old gentleman who presented with acute uncomplicated type B aortic dissection managed by endovascular repair Case illustration: A 78 year-old hypertensive patient admitted to the hospital with persistent chest discomfort and cough for 2 weeks. The CT aortic angiogram showed type B dissection. Based on the recent guidelines, TEVAR should be considered in patients with uncomplicated type B aortic dissection, thus we prepared the patient for TEVAR procedure. First we established multidisciplinary vascular team for the pre-procedural preparation of the patient. We perform careful measurement through detailed CT angiography reconstruction from carotid to femoral arteries. We found proximal diameter was 30-35mm, distal diameter was 23mm and landing zone right after left brachial ostium, suitable for stent graft Valiant Captivia 36-32x150mm. The CT also showed that both femoral artery were normal, we decided to use right femoral artery as the access. We proceed to the procedure 2 days later, under general anaesthesia, digital subtraction angiography revealed dissection of descending aorta, and selected device was inserted. Subsequent contrast injection revealed total occlusion of the false lumen. Patient was transferred to ICU for postprocedural care, and extubated the day after. The hospital stay was uneventful, and one-month follow up CT shows no endoleak. Conclusion : Management of uncomplicated Stanford B dissections is very challenging. TEVAR has emerged as an alternative to surgery with lower morbidity and mortality rates that might offer good long-term results.

scholarly journals Expanding Role of Endovascular Repair for Type B Aortic Dissection

2017 ◽  
Vol 01 (02) ◽  
pp. 089-095
Author(s):  
Sanjiv Sharma ◽  
Arun Sharma
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Adverse Outcome ◽  
Multislice Ct ◽  
Medical Emergency ◽  
Primary Therapy ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type B Dissection

AbstractAortic dissection is a medical emergency that can quickly lead to death, despite optimal treatment. The Stanford classification is widely used and is in close relationship to clinical practice, as type A dissections require primary surgical repair whereas type B dissections are treated medically as initial treatment with surgery or endovascular repair (EVR) reserved for any complications. Multislice CT is the investigation of choice to establish the diagnosis and plan treatment strategies. Therapeutic strategies differ for treatment of an acute dissection compared with a chronic dissection. Traditionally, most institutions favor a “complication specific” approach for type B dissection with antihypertensive treatment and use of β-blockers as primary therapy. Surgery or EVR is reserved for patients with recurrent pain, life-threatening complications, or rapid aortic expansion. With above algorithms, there is evidence that 30 to 50% patients on conservative therapy develop serious morbidity or mortality over 5-year period. Clinical and imaging markers of adverse outcome are being identified to revise the management strategies and offer EVR to those at risk for adverse outcome. This is especially relevant in view of the fact that EVR for type B dissection is associated with procedural success in 99.2 ± 0.1% patients. Overall survival rates of 96.9% at 30 days, 96.7% at 6 months, 96.4% at 1 year, 95.6% at 2 years, and 95.2% at 5 years are reported after EVR in type B dissections. There is emerging evidence that EVR may be noninferior to surgery in this group of patients. These observations along with the development of dissection-specific device designs have the potential to rewrite the management algorithms for type B aortic dissection and define the role of EVR in this disease.

scholarly journals Endovascular repair of acute complicated type B aortic dissection—systematic review and meta-analysis of long-term survival and reintervention

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Ashley R. Wilson-Smith ◽  
Benjamin Muston ◽  
Harish Kamalanathan ◽  
Amanda Yung ◽  
Cheng-Hao Jacky Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Aortic Dissection ◽  
Endovascular Repair ◽  
Meta Analysis ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Term Survival ◽  
Long Term Survival

Endovascular Repair of a Type B Aortic Dissection with Transposition of a Coexistent Aberrant Subclavian (Lusorian) Artery

2002 ◽  
Vol 9 (4) ◽  
pp. 549-553 ◽  
Author(s):  
A.W. Floris Vos ◽  
Willem Wisselink ◽  
Abraham Rijbroek ◽  
Jurgen A. Avontuur ◽  
Radu A. Manoliu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Conventional Surgery ◽  
Entry Site ◽  
Supraclavicular Approach ◽  
Type B Dissection ◽  
The Right ◽  
Lusorian Artery

Purpose: To report the endovascular treatment of a relatively uncommon entity: an aortic type B dissection combined with an aberrant subclavian artery (SA). Case Report: A 59-year-old patient was admitted with chest pain and interscapular back pain. A transesophageal ultrasound and magnetic resonance angiography revealed a type B aortic dissection originating at the level of an aberrant SA orifice. After failure of medical therapy, the dissection was treated by transluminal implantation of an Excluder stent-graft covering the entry site of the dissection at the aberrant SA orifice. Prior to the endovascular procedure, a transposition of the aberrant SA to the right carotid artery was performed through a supraclavicular approach. The patient remains asymptomatic at 19 months after the endovascular repair. Conclusions: Endovascular repair of a type B aortic dissection in the presence of a lusorian artery appears to be a feasible, safe, and less invasive alternative to conventional surgery. The need for concurrent transposition of the SA remains to be determined.

Complications After Endovascular Repair of Type B Aortic Dissection

2002 ◽  
Vol 9 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Reinhard S. Pamler ◽  
Thomas Kotsis ◽  
Johannes Görich ◽  
Xaver Kapfer ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Type B ◽  
Type B Aortic Dissection

Endovascular Repair of a Type B Aortic Dissection With Transposition of a Coexistent Aberrant Subclavian (Lusorian) Artery

2002 ◽  
Vol 9 (4) ◽  
pp. 549-553 ◽  
Author(s):  
A. W. Floris Vos ◽  
Willem Wisselink ◽  
Abraham Rijbroek ◽  
Jurgen A. Avontuur ◽  
Radu A. Manoliu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Lusorian Artery

Management of Residual False Lumen Flow After Thoracic Endovascular Repair in Chronic Type B Aortic Dissection

2020 ◽  
Vol 04 (05) ◽  
Author(s):  
Hervé Rousseau ◽  
Paul Revel-Mouroz ◽  
Charline Zadro ◽  
Camille Dambrin ◽  
Christophe Cron ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
False Lumen ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type ◽  
Thoracic Endovascular Repair
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