Importance of Refractory Pain and Hypertension in Acute Type B Aortic Dissection

Thoracic Endovascular Aortic Repair for Type B Dissection

“…Risk factors of partial thrombosis in the false lumen, total aortic diameter >4 cm, false lumen diameter >2.2 cm, and refractory pain have been shown to be associated with poor long-term outcome and perhaps earlier progression of aortic complications. [14][15][16] Positive aortic remodeling in association with improved long-term outcome and survival in these high-risk patients with rapid progression of disease offer further supportive data that the role of TEVAR in lower risk patients may require a longer time before its benefits can be realized.…”

New Paradigms in the Treatment of Acute Complicated and Uncomplicated Type B Aortic Dissection

“…Refractory pain appears to be a significant risk for mortality (35% risk), and patients with this symptom should be considered complicated as well. 11 Complicated type B aortic dissection is a medical emergency and the general goal of immediate treatment is to lower blood pressure and heart rate to limit shear stress on the aorta and prevent dissection propagation, obstruction to the branch vessels and risk of rupture. 2 Although a historically important approach for the treatment of acute type B aortic dissection, open surgical repair is being chosen less often by surgeons for this disease.…”

“…In a 2010 study using IRAD data, refractory hypertension was found to lead to a 23-fold increase in the rate of mortality compared to medical management. 11 Determining which patients benefit from early TEVAR is still a difficult and debatable clinical decision, and randomized controlled trials are necessary to develop algorithms for management of this complex disease.…”

Acute Aortic Emergencies—Part 2 Aortic Dissections

“…However, opiates may not relieve the patient's pain (Trimachi et al, 2010). Often patients become pain free from nonanalgesic interventions such as blood pressure and heart rate control (Menon et al, 2009).…”