Long-term Evolution of Type B Dissection and Endovascular Therapy Indications

  • Arturo Evangelista
  • Rio Aguilar
  • Teresa González-Alujas
  • Patricia Mahia
  • José Rodríguez-Palomares
Conference paper


The long-term evolution of type B aortic dissection has relatively high mortality or need for surgery, which approach 50% in 5 years. Some clinical predictive such as age, chronic obstructive pulmonary disease, hypertension and Marfan Syndrome factors have been associated with a high risk of complications. However, information obtained by imaging techniques has significant prognostic value. In addition to maximum aorta diameter, the combination of large entry tear size and true lumen compression or partial false lumen thrombosis is the best predictor of mortality and aortic dilatation. In these cases endovascular therapy should be considered in subacute phase. Treatment efficacy is greater in this phase than in chronic phase when the aorta is severely dilated and the intima is less elastic. Indications for stent grafting or surgery in the chronic phase are based on the size and growth of the dissecting aneurysm. Careful blood pressure control and annual follow-up by imaging techniques are necessary to prevent the aortic rupture, and elective endovascular therapy should be considered if aortic diameter exceeds 60 mm or increases significantly (> 5 mm/y).

General consensus exists on the acute management of aortic dissection, surgical treatment in ascending aorta dissection (type A) and medical treatment of descending aorta dissection (type B). In acute type B dissection, surgical or endovascular treament has usually been reserved for complications. In-hospital outcomes are generally acceptable in patients with uncomplicated acute type B dissection, up to 85–90% of whom survive to hospital discharge after receiving effective antihy-pertensive therapy [1]. However, a significant percentage who have successfully survived the acute phase with correct therapeutic management often require surgery during the chronic phase owing to aortic enlargement or, unfortunately, rupture of the aorta.


Aortic Dissection False Lumen Endovascular Therapy Aortic Diameter Acute Aortic Dissection 
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Copyright information

© Springer 2009

Authors and Affiliations

  • Arturo Evangelista
    • 1
  • Rio Aguilar
    • 1
  • Teresa González-Alujas
    • 1
  • Patricia Mahia
    • 1
  • José Rodríguez-Palomares
    • 1
  1. 1.Servei de CardiologíaHospital Universitari Vall d'HebronBarcelona.Spain

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