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The Case for Endovascular Intervention in All Acute Type B Dissections

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Controversies in Aortic Dissection and Aneurysmal Disease

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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.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Matthew D. Forrester MD & Michael D. Dake MD

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Correspondence to Michael D. Dake MD .

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  1. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Robert S. Bonser

  2. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Domenico Pagano

  3. Thoracic and Cardiovascular Surgery Depts., Hannover Medical School, Hannover, Germany

    Axel Haverich

  4. University Hospitals Birmingham, Queen Elizabeth Hospital & Centre, Birmingham, United Kingdom

    Jorge Mascaro

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Forrester, M.D., Dake, M.D. (2014). The Case for Endovascular Intervention in All Acute Type B Dissections. 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_31

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