Skip to main content
SpringerLink
Log in

In Patients with a Chronic Type B Dissection, Does Endovascular Treatment Reduce Long Term Complications?

  • Chapter
  • First Online:
Difficult Decisions in Vascular Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

  • 1020 Accesses

Abstract

Aortic dissection is a highly morbid condition. Acute type B dissection is associated with 13 % 30-day mortality and 83 % 5 year survival [1]. The management of type B dissection remains complex and challenging. Since the introduction of TEVAR technology in the 1990’s it has become a preferred method of treatment of acute and chronic type B dissections. Medical management of chronic type B dissection continues to be a gold standard therapy while the role and timing of TEVAR remains controversial. The objective of this chapter is to describe treatment options for chronic type B dissection and establish possible benefits of endovascular repair in reducing long term complications of chronic type B dissection.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 229.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Howard DPJ, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control. Circulation. 2013;127:2031–7.

    Article  PubMed  Google Scholar 

  2. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340:1546–52.

    Article  CAS  PubMed  Google Scholar 

  3. Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. 1999;340:1539–45.

    Article  CAS  PubMed  Google Scholar 

  4. Zhang H, Wang ZW, Zhou Z, Hu XP, Wu HB, Guo Y. Endovascular stent-graft placement or open surgery for the treatment of acute type B aortic dissection: a meta-analysis. Ann Vasc Syrg. 2012;26:451–61.

    Google Scholar 

  5. Thrumurthy SG, Karthikesalingam A, Patterson BO, Holt PJ, Hinchliffe RJ, Loftus IN, et al. A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg. 2011;42:632–47.

    Article  CAS  PubMed  Google Scholar 

  6. Sayer D, Bratby M, Brooks M, Loftus I, Morgan R, Thompson M. Aortic morphology following endovascular repair of acute and chronic type B aortic dissection: implications for management. Eur J Vasc Endovasc Surg. 2008;36:522–9.

    Article  CAS  PubMed  Google Scholar 

  7. Mani K, Clough RE, Lyons OT, Bell RE, Carrell TW, Zayed HA, et al. Predictors of outcome after endovascular repair for chronic type B dissection. Eur J Vasc Endovasc Surg. 2012;43:3869–91.

    Article  Google Scholar 

  8. Nienaber CA, Kische S, Akin I, et al. Strategies for subacute/chronic type B aortic dissection: the Investigation of Stent Graft in Patients with type B Aortic Dissection (INSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg. 2010;140 suppl 6:S101–8.

    Article  PubMed  Google Scholar 

  9. Nienaber CA, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6(4):407–16.

    Article  CAS  PubMed  Google Scholar 

  10. VIRTUE Registry Investigators. The VIRTUE registry of type B thoracic dissection-study design and early results. Eur J Vasc Endovasc Surg. 2011;41:159–66.

    Article  Google Scholar 

  11. Virtue T, Investigators R. Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE Registry. Eur J Vasc Endovasc Surg. 2014;48:363–71.

    Article  Google Scholar 

  12. Jia X, Guo W, Li T-X, Guan S, Yang R, Liu X, et al. The results of stent graft versus medication therapy for chronic type B dissection. J Vasc Surg. 2013;57:406–14.

    Article  PubMed  Google Scholar 

  13. Alves CMR, da Fonseca JHP, de Souza JAM, Kim HC, Esher G, Buffolo E. Endovascular treatment of type B aortic dissection: the challenge of late success. Ann Thorac Surg. 2009;87:1360–5.

    Article  PubMed  Google Scholar 

  14. Kim U, Hong S-J, Kim J, Kim JS, Ko YG, Choi D, et al. Intermediate to long-term outcomes of endoluminal stent-graft repair in patients with chronic type B aortic dissection. J Endovasc Ther. 2009;16:42–7.

    Article  PubMed  Google Scholar 

  15. Xu SD, Huang FJ, Yang JF, Li ZZ, Yang S, Du JH, et al. Early and midterm results of thoracic endovascular aortic repair of chronic type B aortic dissection. J Thorac Cardiovasc Surg. 2010;139:1548–53.

    Article  PubMed  Google Scholar 

  16. Parsa CJ, Williams JB, Bhattacharya SD, Wolfe WG, Daneshmand MA, McCann RL, et al. Midterm results with thoracic endovascular aortic repair for chronic type B aortic dissection with associated aneurysm. J Thorac Cardiovasc Surg. 2011;141:322–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kang WC, Greenberg RK, Mastracci TM, Eagleton MJ, Hernandez AV, Pujara AC, et al. Endovascular repair of complicated chronic distal aortic dissections: intermediate outcomes and complications. J Thorac Cardiovasc Surg. 2011;142:1074–83.

    Article  PubMed  Google Scholar 

  18. Andacheh ID, Donayre C, Othman F, Walot I, Kopchok G, White R. Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection. J Vasc Surg. 2012;56:644–50.

    Article  PubMed  Google Scholar 

  19. Mani K, Clough RE, Lyons OTA, Bell RE, Carrell TW, Zayed HA, et al. Predictors of outcome after endovascular repair for chronic type B dissection. Eur J Vasc Endovasc Surg. 2012;43:386–91.

    Article  CAS  PubMed  Google Scholar 

  20. Zipfel B, Czerny M, Funovics M, Coppi G, FerroC, Rousseau H, et al. Endovascular treatment of patients with types A and B thoracic aortic dissection using relay thoracic stent- grafts : results from the RESTORE Patient Registry. J Endovasc Ther. 2011;18:131–43.

    Google Scholar 

  21. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. J Am Coll Cardiol. 2010;55:1509–44.

    Article  Google Scholar 

  22. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;287:897–903.

    Article  Google Scholar 

  23. Panneton JM, Hollier LH. Dissecting descending thoracic and thoracoabdominal aortic aneurysms: part II. Ann Vasc Surg. 1995;9:596–605.

    Article  CAS  PubMed  Google Scholar 

  24. Hata M, Shiono M, Inoue T, Sezai A, Niino T, Negishi N, et al. Optimal treatment of type B acute aortic dissection: long-term medical follow-up results. Ann Thorac Surg. 2003;75:1781–4.

    Article  PubMed  Google Scholar 

  25. Winnerkvist A, Lockowandt U, Rasmussen E, Radegran K. A prospective study of medically treated acute type B aortic dissection. Eur J Vasc Endovasc Surg. 2006;32:349–55.

    Article  CAS  PubMed  Google Scholar 

  26. Davies RR, Goldstein LJ, Coady MA, Titttle SL, Rizzo JA, Kopf GS, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg. 2002;73:17–27.

    Article  PubMed  Google Scholar 

  27. Kunishige H, Myojin K, Ishibashi Y, Ishii K, Kawasaki M, Oka J. Predictors of surgical indications for acute type B aortic dissection based on enlargement of aortic diameter during the chronic phase. J Thocac Cardiovasc Surg. 2006;54:477–82.

    Article  Google Scholar 

  28. Song JM, Kim SD, Kim JH, Kim MJ, Kang DH, Seo JB, et al. Long-term predictors of descending aorta aneurysmal change in patients with aortic dissection. J Am Coll Cardiol. 2007;50:799–804.

    Article  PubMed  Google Scholar 

  29. Sueyoshi E, Sakamoto I, Uetani M. Growth rate of affected aorta in patients with type B partially closed artic dissection. Ann Thorac Surg. 2009;88:1251–7.

    Article  PubMed  Google Scholar 

  30. Bernard Y, Zimmermann H, Chocron S, Litzler JF, Kastler B, Etievent JP, et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol. 2001;87:1378–82.

    Article  CAS  PubMed  Google Scholar 

  31. Sueyoshi E, Sakamoto I, Hayashi K, Yamaguchi T, Imada T. Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. Circulation. 2004;110(11 Suppl 1):II256–61.

    PubMed  Google Scholar 

  32. Myyamoto Y, Ohata T, Mistuno M, Yamamura M, Tanaka H, Kobayashi Y, et al. Long-term outcomes after entry closure and aneurysmal wall plication for type B aortic dissection. Eur J Cardio Thorac Surg. 2008;33:152–6.

    Article  Google Scholar 

  33. Zoli S, Etz CD, Roder F, Mueller CS, Brenner RM, BOdian CA, et al. Long-term survival after open repair of chronic aortic dissection. Ann Thorac Surg. 2010;89:1458–66.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Vascular and Endovascular Surgery, North Shore-LIJ, Northwell Health System, New Hyde Park, NY, USA

    Yana Etkin MD

  2. Division of Vascular Surgery and Endovascular Therapy, University Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Ronald M. Fairman MD

Authors
  1. Yana Etkin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronald M. Fairman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yana Etkin MD .

Editor information

Editors and Affiliations

  1. The University of Chicago Medical Center and Biological Science Division, Chicago, Illinois, USA

    Christopher L. Skelly

  2. The University of Chicago Medical Center and Biological Science Division, Chicago, Illinois, USA

    Ross Milner

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Etkin, Y., Fairman, R.M. (2017). In Patients with a Chronic Type B Dissection, Does Endovascular Treatment Reduce Long Term Complications?. In: Skelly, C., Milner, R. (eds) Difficult Decisions in Vascular Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-33293-2_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33293-2_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33291-8

  • Online ISBN: 978-3-319-33293-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation