摘要
Acute type B aortic dissection(TBAD) occurs as a result of an intimal tear within the proximal thoracic aorta. Patients are typically managed acutely with aggressive antihypertensive therapy. Surgical repair is reserved for those who develop complications such as rupture or malperfusion. The surgical management of acute TBAD has changed considerably in the last decade secondary to the advent of thoracic stent grafting. Thoracic endovascular aortic repair(TEVAR) has improved early mortality and morbidity rates for patients presenting with complicated TBAD. The role of TEVAR in patients presenting with acute and subacute uncomplicated TBAD is less clear. TEVAR has been associated with increased late survival and better aortic remodeling, with low perioperative morbidity in selected patients. Recent literature suggests certain radiographic criteria may be used to predict patients developing late aortic events who would benefit from early TEVAR. The purpose of this article is to review the contemporary management of acute TBAD, discuss controversies in management and evaluate the latest research findings.
Acute type B aortic dissection(TBAD) occurs as a result of an intimal tear within the proximal thoracic aorta. Patients are typically managed acutely with aggressive antihypertensive therapy. Surgical repair is reserved for those who develop complications such as rupture or malperfusion. The surgical management of acute TBAD has changed considerably in the last decade secondary to the advent of thoracic stent grafting. Thoracic endovascular aortic repair(TEVAR) has improved early mortality and morbidity rates for patients presenting with complicated TBAD. The role of TEVAR in patients presenting with acute and subacute uncomplicated TBAD is less clear. TEVAR has been associated with increased late survival and better aortic remodeling, with low perioperative morbidity in selected patients. Recent literature suggests certain radiographic criteria may be used to predict patients developing late aortic events who would benefit from early TEVAR. The purpose of this article is to review the contemporary management of acute TBAD, discuss controversies in management and evaluate the latest research findings.
