Indication of endovascular treatment of type B aortic dissection - Literature Review

Abstract

Aortic dissection is a cardiovascular event of high mortality if not early diagnosed and properly treated. In Stanford type A aortic dissection, there is the involvement of the ascending aorta, whereas in type B the ascending aorta is not affected. The treatment of type A aortic dissection is mainly surgical. The hospital mortality of type B aortic dissection surgical treatment is approximately 20%, while medical therapy is 10%. However, half the patients who are discharged from hospital after medical treatment, progress to aortic complications in the following years, and the mortality in three to five years may reach 25-50%. In addition, the surgical treatment of aortic complications after medical treatment, has also a significant mortality. This way, the endovascular treatment comes up as an interesting alternative of a less invasive treatment for this disease. They presented a mortality rate lower than 10% with more than 80% success rate of occlusion and thrombosis of the false lumen. The INSTEAD TRIAL, which randomized patients with uncomplicated type B aortic dissection for optimal medical therapy and endovascular treatment in addition to optimal medical therapy, showed that after three years of follow up, patients who underwent endovascular treatment had lower mortality and aorta-related complications. Therefore, there is a current tendency to recommend the endovascular treatment as a standard for the treatment of type B aortic dissection

Complicated Open Repair of Type B Aortic Dissection in a Patient With Ehlers-Danlos Syndrome Rescued by Endovascular Intervention

“…15 Open vascular reconstruction mortality in patients with vEDS is 20-65% while mortality associated with arteriography in this population is 17%-67%, 16 highlighting the importance of developing targeted approaches for complicated cases. Endovascular repair has emerged as the preferred technique for uncomplicated and complicated Type B or DeBakey Type III aortic dissection, [17][18][19] but such interventions for EDS patients is still debatable. [12][13][14] Given that EDS can contribute to medial degeneration and consequential intimal tears, acute dissection pathophysiology is similar to that of the general population.…”

Expanding Role of Endovascular Repair for Type B Aortic Dissection

“…Studies have shown a mortality rate of < 10% and > 80% success rate of occlusion and thrombosis of the false lumen with EVR. 22 The establishment of the International Registry of Acute Aortic Dissection (IRAD) in 1996, which gathers information from 24 centers in 11 countries, has helped in the development of an understanding of the complexity of AD. 3 At present, the AD-referral centers routinely advocate EVR for complicated type B dissection, as acceptable early and midterm results have shown that there is adequate prevention of aneurysm rupture.…”