Therapie und Versorgung akuter Dissektionen vom Typ Stanford B

Aortic dissection is a potentially fatal entity that demands a high level of clinical suspicion, accurate and prompt diagnosis, a thorough understanding of anatomy and natural history and a multidisciplinary approach to management of this highly variable disease process. Management of aortic dissection is complex and is directed by multiple patient and disease-specific factors requiring a complication-specific approach. Various classification systems have been devised to assist in such decision-making. Moreover, appropriate aortic imaging is critical for both diagnosis and treatment planning. Initial blood pressure and heart rate control and monitoring in the intensive care unit setting are critical. Descending aortic dissections (Stanford B, DeBakey III) complicated by rupture, rapid false lumen expansion, tissue malperfusion, intractable pain or uncontrollable hypertension are likely to require acute intervention. Conversely, uncomplicated type B dissections are typically treated medicinally. With the advent and evolution of endovascular techniques, more treatment options, often less invasive, are becoming available to the clinician. However, there is not yet a clear consensus regarding open surgical repair versus stent-graft and other adjunctive interventions. Further clinical investigation is clearly needed and is ongoing. Ultimately, treatment of aortic dissection will probably employ multiple techniques and more patient and disease-specific approaches. The English full-text version of this article is available at SpringerLink (under supplemental)