Abstract
Acute type B aortic dissection is still associated with significant morbidity and mortality. Traditionally, management has involved medical stabilization with “anti-impulse” therapy to prevent the progression of dissection and the complications of malperfusion and rupture. Despite best medical therapy, complications may still occur, leading to an early mortality of more than 10 %. Although endovascular measures have been demonstrated to improve early survival after complicated acute type B aortic dissection, the use of stent grafts have not demonstrated improved outcomes for the cases of uncomplicated type B aortic dissection. Data on the benefit of stent grafts for promoting “remodeling” in type B aortic dissection has been equivocal. For these reasons, conservative management for uncomplicated type B aortic dissection remains the mainstay for treatment.
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References
Estrera A, Miller CC, Safi HJ, Goodrick J, Keyhani A, Porat EE. Outcomes of medical management of acute type b aortic dissection. Circulation. 2006;114:384–9.
Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg. 1970;10:237–47.
Wheat Jr MW. Acute dissection of the aorta. Cardiovasc Clin. 1981;12:177–96.
Palmer RF, Wheat MW. Management of impending rupture of the aorta with dissection. Adv Intern Med. 1971;17:409–23.
Wheat Jr MW, Shumacker Jr HB. Dissecting aneurysm. Problems of management. Chest. 1976;70:650–5.
Genoni M, Paul M, Jenni R, Graves K, Seifert B, Turina M. Chronic beta-blocker therapy improves outcome and reduces treatment costs in chronic type B aortic dissection. Eur J Cardiothorac Surg. 2001;19:606–10.
Leach SD, Toole AL, Stern H, DeNatale RW, Tilson MD. Effect of beta-adrenergic blockade on the growth rate of abdominal aortic aneurysms. Arch Surg. 1988;123:606–9.
Suzuki T, Isselbacher EM, Nienaber CA, Pyeritz RE, Eagle KA, et al. Type-selective benefits of medications in treatment of acute aortic dissection (from the International Registry of Acute Aortic Dissection [IRAD]). Am J Cardiol. 2012;109:122–7.
Estrera AL, Miller 3rd CC, Safi HJ, Goodrick JS, Keyhani A, et al. Outcomes of medical management of acute type B aortic dissection. Circulation. 2006;114:I384–9.
Kodama K, Nishigami K, Sakamoto T, Sawamura T, Hirayama T, et al. Tight heart rate control reduces secondary adverse events in patients with type B acute aortic dissection. Circulation. 2008;118:S167–70.
Tsai TT, Fattori R, Trimarchi S, Isselbacher E, Myrmel T, et al. Long-term survival in patients presenting with type B acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. Circulation. 2006;114:2226–31.
Tsai TT, Evangelista A, Nienaber CA, Myrmel T, Meinhardt G, et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007;357:349–59.
Fattori R, Botta L, Lovato L, Biagini E, Russo V, et al. Malperfusion syndrome in type B aortic dissection: role of the endovascular procedures. Acta Chir Belg. 2008;108:192–7.
Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, et al. Diagnosis and management of aortic dissection. Eur Heart J. 2001;22:1642–81.
Hata M, Shiono M, Inoue T, Sezai A, Niino T, et al. Optimal treatment of type B acute aortic dissection: long-term medical follow-up results. Ann Thorac Surg. 2003;75:1781–4.
Estrera AL, Miller CC, Goodrick J, Porat EE, Achouh PE, et al. Update on outcomes of acute type B aortic dissection. Ann Thorac Surg. 2007;83:S842–5; discussion S846–50.
Nienaber CA, von Kodolitsch Y, Nicolas V, Siglow V, Piepho A, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med. 1993;328:1–9.
Nienaber CA, Spielmann RP, von Kodolitsch Y, Siglow V, Piepho A, et al. Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography. Circulation. 1992;85:434–47.
Nienaber CA, Rousseau H, Eggebrecht H, Kische S, Fattori R, et al. Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation. 2009;120:2519–28.
Nienaber CA. Influence and critique of the INSTEAD Trial (TEVAR versus medical treatment for uncomplicated type B aortic dissection). Semin Vasc Surg. 2011;24:167–71.
Nienaber CA, Ince H. Stent-grafts for aortic dissection: what is really needed? J Endovasc Ther. 2011;18:144–5.
Nienaber CA, Kische S, Akin I, Rousseau H, Eggebrecht H, et al. Strategies for subacute/chronic type B aortic dissection: the Investigation of Stent Grafts in Patients with type B Aortic Dissection kINSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg. 2010;140:S101–8; discussion S142–6.
Akin I, Kische S, Rehders TC, Ince H, Nienaber CA. Thoracic endovascular stent-graft therapy in aortic dissection. Curr Opin Cardiol. 2010;25:552–9.
Nienaber CA. Stent implantation or surgical treatment for chronic and acute aortic dissection—for stent implantation. Dtsch Med Wochenschr. 2010;135:621–2.
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Guajardo-Salinas, G., Estrera, A.L., Safi, H.J. (2014). Conservative Management of Acute Type B Dissection. In: Bonser, R., Pagano, D., Haverich, A., Mascaro, J. (eds) Controversies in Aortic Dissection and Aneurysmal Disease. Springer, London. https://doi.org/10.1007/978-1-4471-5622-2_30
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DOI: https://doi.org/10.1007/978-1-4471-5622-2_30
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