Predictors of late aortic intervention in patients with medically treated type B aortic dissection

Abstract

Nearly 40% of patients who present with an uncomplicated TBAD will ultimately require an aortic intervention. All of the late interventions were performed for aneurysmal degeneration. A variety of readily available anatomic features can predict the need for eventual operative intervention in TBAD; accordingly, these parameters can guide the desirability of early TEVAR.

Open Surgical Repair of Abdominal Aortic Aneurysms Maintains a Pivotal Role in the Endovascular Era

“…42 In a recent study in medically managed chronic DeBakey IIIB dissections, 83% of those with aneurysmal degeneration required aortic intervention. 43 Often, aneurysm formation in chronic dissection affects the thoracic and abdominal aorta, requiring an extensive TAAA repair with relatively high rates of paraplegia. Staged procedures in which TEVAR is performed in adjunct with open extent III or extent IV TAAA repair have been described and may decrease paraplegic risk and enhance the technical feasibility of repair.…”

Extended Arch Procedures for Acute Type A Aortic Dissection: A Downstream Problem?

“…Large (> 1cm), proximal intimal tears ATAAD, 6,30 and tears on the concave surface of the proximal descending aorta in acute type B dissection 31 have been associated with poorer outcomes. However, small tears, whether proximal or not, had excellent survival at 10 years.…”

“…A frequent cutoff differentiating excellent from inferior outcomes is 40 mm. 9,15,30,32,33 False lumen patency is another parameter often correlated with outcomes, and studies have variously focused on false lumen size, 11,30,35 shape, degree of thrombosis, 36 and capacity of outflow branches. 37 An important observation regarding false lumen measurements in the acute phase is that the dissection membrane is dynamic and moves throughout the cardiac cycle, making false lumen size measurement by one fixed CT image misleading.…”

Acute Type B Dissection

“…Thrombosis of the false lumen was deemed protective. 38 These studies have put forward convincing data that best medical therapy may not be adequate in all cases and there is a role for TEVAR where the risk of procedure outweighs the risk of aortic-specific mortality.…”