Treatment of uncomplicated type B aortic dissection

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• 作者：Hitoshi Matsuda
• 关键词：Aortic dissection ; TEVAR ; Uncomplicated dissection
• 刊名：General Thoracic and Cardiovascular Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：65
• 期：2
• 页码：74-79
• 全文大小：
• 刊物主题：Thoracic Surgery; Cardiac Surgery; Cardiology; Surgical Oncology;
• 出版者：Springer Japan
• ISSN：1863-6713
• 卷排序：65

文摘

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.