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Early and late management of type B aortic dissection
  1. Christoph A Nienaber1,
  2. Dimitar Divchev1,
  3. Holger Palisch2,
  4. Rachel E Clough3,
  5. Barbara Richartz4
  1. 1Department of Cardiology, University Heart Centre Rostock, University of Rostock, Rostock, Germany
  2. 2Hospital Dresden-Friedrichstadt, Dresden, Germany
  3. 3Cardiovascular Imaging Department, King's College London, London, UK
  4. 4Privatklinik Jägerwinkel, Bad Wiessee, Germany
  1. Correspondence to Dr Christoph A Nienaber, Department of Internal Medicine I, Heart Centre Rostock, University of Rostock, Ernst-Heydemann-Str. 6, Rostock 18055, Germany; christoph.nienaber{at}med.uni-rostock.de

Abstract

The management of type B aortic dissection is undergoing profound changes with timely TEVAR accepted as first-line strategy in the setting of complicated dissection; with recent technological advances and in experienced hands this intervention is considered safe and life-saving. With the ability to remodel the dissected aorta as a result of scaffolding even pre-emptive endovascular treatment is being considered and supported by long-term stability and often prevention of aneurysmal expansion. This insight and a growing number of silent risk conditions (resistant hypertension, partial false lumen thrombosis) may lower the threshold for TEVAR in asymptomatic patients in the subacute phase. In the chronic phase of a type B dissection patients are usually free of symptoms, however, with the expanding false lumen at risk of rupture. Advanced TEVAR options (including branches and fenestrations) are likely to be used more often than open surgical replacement of such aneurysmatic segment of the dissected aorta in that chronic phase. All dissection patients should be offered lifelong surveillance.

  • Aorta
  • Great Vessels and Trauma

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