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World J Surg Proced. Jul 28, 2015; 5(2): 208-216
Published online Jul 28, 2015. doi: 10.5412/wjsp.v5.i2.208
Current management of acute type B aortic dissection
Sina Iranmanesh, John J Ricotta
Sina Iranmanesh, Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC 20010, United States
John J Ricotta, Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, United States
Author contributions: Iranmanesh S and Ricotta JJ solely contributed to this paper.
Conflict-of-interest statement: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sina Iranmanesh, MD, Department of Vascular Surgery, Medstar Washington Hospital Center, POB 3150 North, 110 Irving St NW, Washington, DC 20010, United States. sina.iranmanesh@gmail.com
Telephone: +1-813-4169360 Fax: +1-866-6329121
Received: November 8, 2014
Peer-review started: November 8, 2014
First decision: January 20, 2015
Revised: February 23, 2015
Accepted: March 30, 2015
Article in press: April 2, 2015
Published online: July 28, 2015
Processing time: 242 Days and 1.1 Hours
Abstract

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.

Keywords: Aorta thoracic; Vascular grafting; Aneurysm dissecting; Aortic rupture; Endovascular procedure; Stent

Core tip: Current recommendations and controversies within the surgical management of acute type B aortic dissection are discussed. The increased use of thoracic endovascular aortic repair has been associated with improved patient outcomes, though data on patients presenting with acute and subacute dissection is less clear. Certain radiographic findings may predict those at higher risk of developing late aortic-related complication.