Abstract
Acute type B aortic dissection is a complex pathological process with variable clinical manifestations ranging from uncomplicated vascular involvement to complicated sequelae that can be catastrophic. Specific treatment strategies are determined by a combination of location and extent of the dissection, time from onset of symptoms, co-morbid patient risk factors, and dissection-related complications such as branch vessel (arch, visceral, lower extremity) ischemic compromise or impending rupture. Despite significant improvement in operative mortality for acute type B dissections, it remains high in the presence of visceral ischemia and rupture. The recent development of endovascular interventions provides a less invasive, more expeditious management alternative to stabilize the dissection, prevent rupture, and restore critical branch vessel perfusion. The option of endovascular treatment includes a suite of procedures including aortic stent-graft placement, percutaneous balloon fenestration of the dissection septum, and branch vessel stenting. Currently, endovascular intervention for acute complicated type B dissections is generally accepted as an appropriate treatment modality. It remains unclear however, whether stent-graft placement for uncomplicated type B dissection is beneficial in preventing disease progression. Ongoing and future randomized trials may help to create a consensus regarding the advisability of intervening acutely on all type B aortic dissections.
Original language | English (US) |
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Title of host publication | Controversies in Aortic Dissection and Aneurysmal Disease |
Publisher | Springer-Verlag London Ltd |
Pages | 339-353 |
Number of pages | 15 |
ISBN (Electronic) | 9781447156222 |
ISBN (Print) | 1447156218, 9781447156215 |
DOIs | |
State | Published - Jan 1 2014 |
Externally published | Yes |
Keywords
- Acute type B
- Aortic dissection
- Branch malperfusion
- Endovascular intervention
- Flap fenestration
- Rupture
- Stent-graft
ASJC Scopus subject areas
- General Medicine