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Modern Management of Type B Aortic Dissections

  • Vascular Surgery (S Toursavadkohi, Section Editor )
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Abstract

Purpose of Review

The following describes the recent advancement in the diagnosis, imaging, and treatment of type B aortic dissections. We will review the recent updates of aortic dissection classifications, and potential impact on clinical management.

Recent Findings

Type B aortic dissections can be classified anatomically and temporally using the recent Society for Vascular Surgery and Society of Thoracic Surgeons reporting standards. A number of high-risk features have been correlated with poor prognoses with medical management alone, leading to the expansion of indications for thoracic endovascular aortic repair (TEVAR). Emerging data suggest that timing of intervention may play a role in patient outcomes. Special attention to endovascular technique regarding landing zones and device selection can also significantly impact patient outcomes.

Summary

Anti-impulse therapy should promptly be initiated for all dissections. Type A dissections continue to depend largely on emergent open surgical intervention, whereas TEVAR remains first line for complicated type b aortic dissections. Uncomplicated type b aortic dissections are historically managed conservatively; however, data continue to emerge suggesting benefits of early endovascular intervention to prevent risk of late aortic degeneration or rupture. These approaches continue to be challenged as growing registry data and progressive endovascular technology develop. Regardless of initial management strategy, continued surveillance is crucial. Widespread utilization of standardized classification systems can aid in understanding the natural history and outcomes of aortic dissections.

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  1. Division of Vascular Surgery and Endovascular Therapy, Comprehensive Aortic Center, Keck Medical Center of University of Southern California, 1520 San Pablo St Ste 4300, Los Angeles, CA, 90033, USA

    Alyssa J. Pyun & Sukgu M. Han

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Correspondence to Sukgu M. Han.

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Alyssa J Pyun, MD declares that she has no conflict of interest. Sukgu M Han, MD MS is a consultant for WL Gore and associates, Cook Medical, Terumo Aortic, Medtronic.

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Pyun, A.J., Han, S.M. Modern Management of Type B Aortic Dissections. Curr Surg Rep 9, 22 (2021). https://doi.org/10.1007/s40137-021-00299-1

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