Type B Aortic Dissection

Thomas Luebke; Jan Brunkwall

doi:10.12945/j.aorta.2014.14-040

AORTA, Inhaltsverzeichnis

CC BY 4.0 · Aorta (Stamford) 2014; 02(06): 265-278
DOI: 10.12945/j.aorta.2014.14-040

State-of-the-Art Review

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Type B Aortic Dissection

A Review of Prognostic Factors and Meta-analysis of Treatment Options

Autor*innen

Thomas Luebke

¹Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
Jan Brunkwall

¹Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany

Abstract

Based on a Presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA)

According to international guidelines, stable patients with uncomplicated Type B aortic dissection (TBAD) should receive optimal medical treatment. Despite adequate antihypertensive therapy, the long-term prognosis of these patients is characterized by a significant aortic aneurysm formation in 25-30% within four years, and survival rates from 50 to 80% at five years and 30 to 60% at 10 years. In a prospective randomized trial, preemptive thoracic endovascular aortic repair (TEVAR) in patients with chronic uncomplicated TBAD was associated with an excess early mortality (due to periprocedural hazards), but the procedure showed its benefit in prevention of aortic-specific mortality at five years of follow-up. However, preemptive TEVAR may not be the treatment of choice in all patients with uncomplicated TBAD because of the inherent periprocedural complications like stroke, paraparesis, and death, as well as stent graft-induced complications (i.e., retrograde dissection or endoleaks). Thus, the TEVAR-related deaths and complications (especially paraplegia and stroke) raise concerns that moderate the better survival with TEVAR at five years. By timely identification of those patients prone for developing complications, early intervention, preferably in the subacute or early chronic phase, may improve the overall long-term outcome for these patients. Therefore, early detectable and reliable prognostic factors for adverse events are essential to stratify patients who can be treated medically and those who will benefit from rigorous follow-up and, in the long-term, from timely, or even prophylactic, TEVAR. Several studies have identified prognostic factors in TBAD such as aortic diameter, partial false lumen thrombosis, false lumen thickness, and location of the primary entry tear. Combining these clinical and radiological predictors may be essential to implement a patient-specific approach designed to intervene only in those patients who are at high risk of developing complications to improve the long-term outcomes of patients with uncomplicated Type B aortic dissection.

Key Words

Type B aortic dissection - Endovascular - Thoracic aorta

Volltext

Referenzen

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