Advertisement

Distal Aortic Dissection Type Stanford B

  • E. Sebastian Debus
  • Reinhart T. Grundmann
Chapter

Abstract

The guidelines and consensus recommendations for the treatment of uncomplicated and complicated acute, subacute and chronic aortic dissections Type B are outlined. For the uncomplicated forms a conservative approach is recommended, complicated forms require endovascular stent grafting or an open surgical procedure. Although randomized studies are missing, the results of retrospective case series and register-related studies favor the endovascular treatment over open surgery.

Keywords

Aortic Dissection False Lumen Acute Aortic Dissection True Lumen Spinal Cord Ischemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Afifi RO, Sandhu HK, Leake SS, et al. Outcomes of patients with acute type B (DeBakey III) aortic dissection: a 13-year, single-center experience. Circulation. 2015;132:748–54.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. Bavaria JE, Brinkman WT, Hughes GC, Khoynezhad A, Szeto WY, Azizzadeh A, Lee WA, White RA. Outcomes of thoracic endovascular aortic repair in acute type B aortic dissection: results from the Valiant United States Investigational Device Exemption Study. Ann Thorac Surg. 2015;100:802–8.CrossRefPubMedGoogle Scholar
  4. Brunkwall J, Lammer J, Verhoeven E, Taylor P. ADSORB: a study on the efficacy of endovascular grafting in uncomplicated acute dissection of the descending aorta. Eur J Vasc Endovasc Surg. 2012;44:31–6.CrossRefPubMedGoogle Scholar
  5. Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P, the ADSORB Trialists. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg. 2014;48:285–91.CrossRefPubMedGoogle Scholar
  6. Charilaou P, Ziganshin BA, Peterss S, et al. Current experience with acute type B aortic dissection: validity of the complication-specific approach in the present era. Ann Thorac Surg. 2016;101:936–43.CrossRefPubMedGoogle Scholar
  7. Conway AM, Sadek M, Lugo J, Pillai JB, Pellet Y, Panagopoulos G, Carroccio A, Plestis K. Outcomes of open surgical repair for chronic type B aortic dissections. J Vasc Surg. 2014;59:1217–23.CrossRefPubMedGoogle Scholar
  8. Durham CA, Cambria RP, Wang LJ, Ergul EA, Aranson NJ, Patel VI, Conrad MF. The natural history of medically managed acute type B aortic dissection. J Vasc Surg. 2015b;61:1192–8.CrossRefPubMedGoogle Scholar
  9. Durham CA, Aranson NJ, Ergul EA, Wang LJ, Patel VI, Cambria RP, Conrad MF. Aneurysmal degeneration of the thoracoabdominal aorta after medical management of type B aortic dissections. J Vasc Surg. 2015a;62:900–6.CrossRefPubMedGoogle Scholar
  10. Erbel R, Aboyans V, Boileau C, et al.; ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.Google Scholar
  11. Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, Rousseau H, Schepens M. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol. 2013b;61:1661–78.CrossRefPubMedGoogle Scholar
  12. Fattori R, Montgomery D, Lovato L, Kische S, Di Eusanio M, Ince H, Eagle KA, Isselbacher EM, Nienaber CA. Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc Interv. 2013a;6:876–82.CrossRefPubMedGoogle Scholar
  13. Fujikawa T, Yamamoto S, Sekine Y, Oshima S, Kasai R, Mochida Y, Ozaki K, Sasaguri S. Operative results and clinical features of chronic Stanford Type B aortic dissection: examination of 234 patients over 6 years. Eur J Vasc Endovasc Surg. 2015;50:738–43.CrossRefPubMedGoogle Scholar
  14. Grommes J, Greiner A, Bendermacher B, et al. Risk factors for mortality and failure of conservative treatment after aortic type B dissection. J Thorac Cardiovasc Surg. 2014;148:2155–60.CrossRefPubMedGoogle Scholar
  15. Hanna JM, Andersen ND, Ganapathi AM, McCann RL, Hughes GC. Five-year results for endovascular repair of acute complicated type B aortic dissection. J Vasc Surg. 2014;59:96–106.CrossRefPubMedGoogle Scholar
  16. Hiratzka LF, Bakris GL, Beckman JA, 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: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121:e266–369.CrossRefPubMedGoogle Scholar
  17. Hogendoorn W, Hunink MG, Schlösser FJ, Moll FL, Sumpio BE, Muhs BE. Endovascular vs. open repair of complicated acute type B aortic dissections. J Endovasc Ther. 2014;21:503–14.CrossRefPubMedGoogle Scholar
  18. Jia X, Guo W, Li TX, Guan S, Yang RM, Liu XP, Zhang MH, Xiong J. The results of stent graft versus medication therapy for chronic type B dissection. J Vasc Surg. 2013;57:406–14.CrossRefPubMedGoogle Scholar
  19. Jones DW, Goodney PP, Nolan BW, Brooke BS, Fillinger MF, Powell RJ, Stone DH. National trends in utilization, mortality, and survival after repair of type B aortic dissection in the Medicare population. J Vasc Surg. 2014;60:11–9.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Luebke T, Brunkwall J. Cost-effectiveness of endovascular versus open repair of acute complicated type B aortic dissections. J Vasc Surg. 2014a;59:1247–55.CrossRefPubMedGoogle Scholar
  21. Luebke T, Brunkwall J. Type B aortic dissection: a review of prognostic factors and meta-analysis of treatment options. Aorta (Stamford). 2014b;2:265–78.CrossRefGoogle Scholar
  22. Mani K, Clough RE, Lyons OT, Bell RE, Carrell TW, Zayed HA, Waltham M, Taylor PR. Predictors of outcome after endovascular repair for chronic type B dissection. Eur J Vasc Endovasc Surg. 2012;43:386–91.CrossRefPubMedGoogle Scholar
  23. Mody PS, Wang Y, Geirsson A, Kim N, Desai MM, Gupta A, Dodson JA, Krumholz HM. Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011. Circ Cardiovasc Qual Outcomes. 2014;7:920–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Moulakakis KG, Mylonas SN, Dalainas I, Kakisis J, Kotsis T, Liapis CD. Management of complicated and uncomplicated acute type B dissection. A systematic review and meta-analysis. Ann Cardiothorac Surg. 2014;3:234–46.PubMedPubMedCentralGoogle Scholar
  25. Nienaber CA, Kische S, Rousseau H, et al.; INSTEAD-XL trial. 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;6:407–16.Google Scholar
  26. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015;66:350–8.CrossRefPubMedGoogle Scholar
  27. Patel HJ, Williams DM, Meerkov M, Dasika NL, Upchurch Jr GR, Deeb GM. Long-term results of percutaneous management of malperfusion in acute type B aortic dissection: implications for thoracic aortic endovascular repair. J Thorac Cardiovasc Surg. 2009;138:300–8.CrossRefPubMedGoogle Scholar
  28. Ramdass M. TEVAR for symptomatic Stanford B dissection: a systematic review of 30-day mortality and morbidity. Thorac Cardiovasc Surg. 2015;63:97–112.PubMedGoogle Scholar
  29. Schaffer JM, Lingala B, Miller DC, Woo YJ, Mitchell RS, Dake MD. Midterm survival after thoracic endovascular aortic repair in more than 10,000 Medicare patients. J Thorac Cardiovasc Surg. 2015a;149:808–20.CrossRefPubMedGoogle Scholar
  30. Schaffer JM, Lingala B, Fischbein MP, Dake MD, Woo YJ, Mitchell RS, Miller DC. Midterm outcomes of open descending thoracic aortic repair in more than 5,000 Medicare patients. Ann Thorac Surg. 2015b;100:2087–94.CrossRefPubMedGoogle Scholar
  31. Shah TR, Rockman CB, Adelman MA, Maldonado TS, Veith FJ, Mussa FF. Nationwide comparative impact of thoracic endovascular aortic repair of acute uncomplicated type B aortic dissections. Vasc Endovasc Surg. 2014;48:230–3.CrossRefGoogle Scholar
  32. Steuer J, Eriksson MO, Nyman R, Björck M, Wanhainen A. Early and long-term outcome after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection. Eur J Vasc Endovasc Surg. 2011;41:318–23.CrossRefPubMedGoogle Scholar
  33. Svensson LG, Kouchoukos NT, Miller DC, et al.; Society of Thoracic Surgeons Endovascular Surgery Task Force. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg. 2008;85:S1–41.Google Scholar
  34. Thrumurthy SG, Karthikesalingam A, Patterson BO, Holt PJ, Hinchliffe RJ, Loftus IM, Thompson MM. 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.CrossRefPubMedGoogle Scholar
  35. Tian DH, De Silva RP, Wang T, Yan TD. Open surgical repair for chronic type B aortic dissection: a systematic review. Ann Cardiothorac Surg. 2014;3:340–50.PubMedPubMedCentralGoogle Scholar
  36. Trimarchi S, Jonker FH, Muhs BE, Grassi V, Righini P, Upchurch GR, Rampoldi V. Long-term outcomes of surgical aortic fenestration for complicated acute type B aortic dissections. J Vasc Surg. 2010;52:261–6.CrossRefPubMedGoogle Scholar
  37. van Bogerijen GH, Tolenaar JL, Rampoldi V, Moll FL, van Herwaarden JA, Jonker FH, Eagle KA, Trimarchi S. Predictors of aortic growth in uncomplicated type B aortic dissection. J Vasc Surg. 2014;59:1134–43.CrossRefPubMedGoogle Scholar
  38. van Bogerijen GH, Patel HJ, Williams DM, Yang B, Dasika NL, Eliason JL, Deeb GM. Propensity adjusted analysis of open and endovascular thoracic aortic repair for chronic type B dissection: a twenty-year evaluation. Ann Thorac Surg. 2015;99:1260–6.CrossRefPubMedGoogle Scholar
  39. Vendrell A, Frandon J, Rodiere M, Chavanon O, Baguet JP, Bricault I, Boussat B, Ferretti GR, Thony F. Aortic dissection with acute malperfusion syndrome: endovascular fenestration via the funnel technique. J Thorac Cardiovasc Surg. 2015;150:108–15.CrossRefPubMedGoogle Scholar
  40. Wiedemann D, Ehrlich M, Amabile P, Lovato L, Rousseau H, Evangelista-Masip A, Moeller P, Bavaria J. Emergency endovascular stent grafting in acute complicated type B dissection. J Vasc Surg. 2014;60:1204–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • E. Sebastian Debus
    • 1
  • Reinhart T. Grundmann
    • 2
  1. 1.Department of Vascular MedicineUniversity Heart and Vascular Center at University Clinics Hamburg–EppendorfHamburgGermany
  2. 2.Former Medical DirectorCommunity Hospital Altoetting-BurghausenBurghausenGermany

Personalised recommendations