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Management of Uncomplicated Type B Aortic Dissection

1
Cardiology and Aortic Centre, Royal Brompton and Harefield Hospital NHS Foundation Trust, London SW3 6NP, UK
2
Department of Cardiology, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London SW3 6LY, UK
3
School of Biomedical Engineering and Imaging Science, King’s College London, St Thomas’ Hospital, London SE1 7EH, UK
4
Department of Vascular Surgery, St George’s Hospital, London SW17 0QT, UK
*
Author to whom correspondence should be addressed.
Hearts 2020, 1(1), 14-24; https://doi.org/10.3390/hearts1010004
Received: 16 April 2020 / Revised: 9 May 2020 / Accepted: 14 May 2020 / Published: 18 May 2020
(This article belongs to the Special Issue Thoracic Aorta)
Acute aortic dissection has an incidence of approximately half that of symptomatic abdominal and thoracic aneurysm of the aorta and more than twice the mortality of population-based controls. While urgent undelayed open surgery is the strategy of choice in proximal dissection, medical management has been the mainstay of treatment for uncomplicated distal or type B aortic dissection, but endovascular intervention is now considered a potential treatment option for all type B dissection due to its success in complicated cases. Endovascular repair can be technically demanding in aortic dissection, and timing of the repair can have a significant influence on anatomical and clinical outcome. Observational reports of feasibility and reasonable safety are flanked by only two randomised trials; the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial demonstrated improved remodelling in acute dissection and the INvestigation of STEnt grafts in patients with type B Aortic Dissections (INSTEAD) trial showed better long-term survival in patients treated endovascularly in the subacute phase. Meta-analyses and other large clinical studies have demonstrated mixed results. Due to some risks associated endovascular repair and the requirement of specialist aortic care (which is not always available), a pragmatic approach for current management could involve high intensity serial imaging in the acute phase of a type B aortic dissection, thereby identifying complicated cases for early intervention and selection of patients at high risk of disease progression for deferred endovascular management in the subacute phase within 90 days. View Full-Text
Keywords: uncomplicated type B aortic dissection; TEVAR; optimal medical management; aortic dissection; CT uncomplicated type B aortic dissection; TEVAR; optimal medical management; aortic dissection; CT
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MDPI and ACS Style

Yuan, X.; Clough, R.E.; Nienaber, C.A. Management of Uncomplicated Type B Aortic Dissection. Hearts 2020, 1, 14-24. https://doi.org/10.3390/hearts1010004

AMA Style

Yuan X, Clough RE, Nienaber CA. Management of Uncomplicated Type B Aortic Dissection. Hearts. 2020; 1(1):14-24. https://doi.org/10.3390/hearts1010004

Chicago/Turabian Style

Yuan, Xun; Clough, Rachel E.; Nienaber, Christoph A. 2020. "Management of Uncomplicated Type B Aortic Dissection" Hearts 1, no. 1: 14-24. https://doi.org/10.3390/hearts1010004

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