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Treatment of uncomplicated type B aortic dissection

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Abstract

Hospital mortality after the replacement of chronic type B aortic dissection is around 8–10% and adverse outcomes include paraplegia and stroke. However, the level of evidence for indication of thoracic endovascular aortic repair (TEVAR) for type B chronic aortic dissection is Class IIa. Results of the INSTEAD-XL trial have verified that preemptive TEVAR for uncomplicated type B aortic dissection improves prognosis. The indication for this procedure is reportedly a maximum aortic diameter >40 mm during the acute phase and a patent primary entry site in the thoracic aorta, while the optimal timing for TEVAR would be the subacute phase, from 2 weeks to 3–6 months after onset. Prevention of chronic type B aortic dissection with aneurysmal degeneration and attainment of aortic remodeling with preemptive TEVAR are needed to free patients from the need for long-term strict control of blood pressure and periodic follow-ups involving radiological exposure and to avoid the eventual need for extensive open surgery.

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  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Japan

    Hitoshi Matsuda

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  1. Hitoshi Matsuda
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Correspondence to Hitoshi Matsuda.

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Matsuda, H. Treatment of uncomplicated type B aortic dissection. Gen Thorac Cardiovasc Surg 65, 74–79 (2017). https://doi.org/10.1007/s11748-016-0734-0

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