Asian Cardiovasc Thorac Ann 2008;16:272-273
© 2008 Asia Publishing EXchange Ltd
Endovascular Management of Complicated Acute Type B Aortic Dissection
Yiu Che Chan, MD,
Stephen WK Cheng, MS
Hong Kong, China
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Despite having a better survival prognosis than acute dissection of the ascending aorta (type A), acute type B aortic dissection sparing the ascending aorta is associated with substantial morbidity and mortality. Even for initially stable patients, the mortality rate is close to 9.6%, with the most common cause of death being sudden rupture or end-organ malperfusion.1 The timing of these complications is very variable and unpredictable. From the International Registry of Acute Aortic Dissection (IRAD), involving 498 patients, Tsai and colleagues2 showed that arch involvement (127/498, 25.5%) is not associated with higher follow-up mortality, provided blood pressure control is meticulous. Long-term survival in medically managed patients is estimated to be approximately 80% at 1 year, 72% at 3 years, and 58%–76% at 5 years.3,4 Overall, of those who remain stable and asymptomatic, 70% will not require any future surgical intervention, but continual surveillance to prevent late complications such as aneurysmal dilatation is important.5
The treatment of uncomplicated type B dissections is mainly medical with antihypertensives (beta blockers). The management of patients with complications of acute type B aortic dissection (including contained rupture, malperfusion of visceral organs or extremities, rapid increase of aortic diameter, refractory hypertension, and persistent severe pain) is more challenging and controversial. Conventional emergency open surgical intervention with replacement of . . . [Full Text of this Article]
Copyright © 2008 by the Asia Publishing EXchange Ltd.
