The case for endovascular intervention in all acute type B dissections

Matthew D. Forrester, Michael D. Dake

Research output: Chapter in Book/Report/Conference proceedingChapter

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 languageEnglish (US)
Title of host publicationControversies in Aortic Dissection and Aneurysmal Disease
PublisherSpringer-Verlag London Ltd
Pages339-353
Number of pages15
ISBN (Electronic)9781447156222
ISBN (Print)1447156218, 9781447156215
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Keywords

  • Acute type B
  • Aortic dissection
  • Branch malperfusion
  • Endovascular intervention
  • Flap fenestration
  • Rupture
  • Stent-graft

ASJC Scopus subject areas

  • Medicine(all)

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