Is medical therapy still the optimal treatment strategy for patients with acute type B aortic dissections?

Abstract

The prognosis for patients with acute type B aortic dissection is bleak and determined primarily by dissection-related and patient-specific risk factors, which do not appear to be readily modifiable.

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

“…A report from the International Registry of Acute Aortic Dissection (IRAD) identified an in‐hospital surgical mortality rate of 30% in AAD type A patients and 13% in type B 2, 3. However, long‐term outcomes for AAD patients with type B dissection are not necessarily better than those having type A. Long‐term survival of surgically treated patients with type B AAD after discharge ranges from 56% to 96% at 1 year and from 48% to 83% at 5 years 4, 5, 6, 7, 8. In contrast, for surgically treated type A patients who survive until hospital discharge, survival rates range from 52% to 96% at 1 year and from 37% to 91% at 5 years 8, 9, 10, 11, 12.…”

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

“…Acute thoracic aortic dissection involving the de scending aorta should be managed medically unless life-threatening complications develop (ie, malperfusion syndrome, progression of dissection, enlarging aneurysm, inability to control blood pressure or symptoms). 80,[92][93][94][95][96] …”

Intensive blood pressure control in patients with acute type B aortic dissection (RAID): study protocol for randomized controlled trial

“…The long-term survival of ABAD is still low though great improved in medication optimization and surgical repair technique in the past decades. It was reported that 5-and 10-year survival rates for ABAD were 60% and 35% respectively (3). As the development of minimally invasive techniques in recent years, the endovascular repair procedure has become a routine procedure in the treatment of patient with ABAD, this rendered an improved prognosis with a 5-year survival rate close to 80% (4).…”