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Chronic Type B Aortic Dissection

  • Konstantinos SpanosEmail author
  • Tilo Kölbel
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Abstract

One of the major pathologic aortic entities is aortic dissection (AD). The classification as “chronic” was set for patients with type B dissection (CTBAD) initially beyond a two-week time-period, and lately >90 days, introducing a subacute phase from day 15 to 90. Best medical treatment is the cornerstone of therapy in all phases, although there are specific and relative indications for when to intervene in patients with CTBAD. Nowadays, open surgical repair (OSR) of CTBAD is limited to highly specialized vascular centers with extensive experience in open thoracoabdominal aortic repair. However, the endovascular treatment (TEVAR) is the preferred treatment option for CTBAD, compared to OSR, and has been evaluated in population-based studies and registries. Recently, new devices have been developed with either fenestrations or branches, for cases where a more proximal sealing zone is needed. In CTBAD, TEVAR alone has been shown to be beneficial, but with a relatively high rate of failure of false lumen thrombosis due to continued false lumen perfusion from distal entry-tears. Many techniques have been applied for induction of false lumen thrombosis after TEVAR such as Candy-plug, the Knickerbocker, vascular and iliac plugs, coils and liquid embolization techniques. Finally, there are some issues concerning CTBAD that still need clarification. Adherence to medical treatment remains a major concern, as this factor may influence the clinical outcome. Emerging evidence suggests that physical exercise is probably doing more good than harm for patients with CTBAD. Sudden change from being a ‘healthy’ individual to becoming a patient with a life threatening condition may have an impact on the quality of life.

Keywords

Cerebrospinal fluid drainage Chronic type B aortic dissection Motor evoked potentials Open surgical repair Thoracic endovascular aortic repair TEVAR 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.German Aortic Center Hamburg, University Heart CenterUniversity Hospital Hamburg-EppendorfHamburgGermany
  2. 2.Vascular Surgery Department, University Hospital of LarisaUniversity of ThessalyThessalyGreece

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