Management of Type B Aortic Dissections: Treatment of Acute Dissections and Acute Complications from Chronic Dissections
| Autor: | Dolly Thakkar, Michael D. Dake |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Disease 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences Blood Vessel Prosthesis Implantation 0302 clinical medicine Aneurysm Postoperative Complications Blood vessel prosthesis Risk Factors medicine.artery Ascending aorta medicine Thoracic aorta Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine Aortic dissection Surgical repair business.industry Endovascular Procedures medicine.disease Surgery Blood Vessel Prosthesis Dissection Aortic Dissection Acute Disease Stents Cardiology and Cardiovascular Medicine business Tomography X-Ray Computed |
| Zdroj: | Techniques in vascular and interventional radiology. 21(3) |
| ISSN: | 1557-9808 |
| Popis: | Aortic dissection is one of the most catastrophic vascular challenges faced by interventionalists, often misdiagnosed and frequently associated with devastating consequences. Stanford type B aortic dissections affects the descending thoracic aorta without any involvement of the ascending aorta. Dissections associated with refractory pain, rapid aneurysm formation, malperfusion syndromes, rupture, or impending rupture are categorized as complicated and distinct from initially uncomplicated type B dissections without the aforementioned complications. Traditionally, uncomplicated type B dissection is managed medically whereas complicated type B dissection requires intervention to limit mortality. Over the last two decades, thoracic endovascular aortic repair (TEVAR) has emerged as an alternative to open surgical repair for treatment of complicated type B dissection. Various societal guidelines now unanimously propose TEVAR as the treatment of choice for management of complicated disease based on its relatively low morbidity and mortality compared to open surgical outcomes. As the consensually acknowledged standard of care for management of patients with complicated lesions, TEVAR is currently being considered for select patients with initially uncomplicated dissection to mitigate the risks of mid and late-term disease progression and aortic-related mortality. This article describes the decision-making treatment algorithm for management of type B aortic dissection. It also provides a comprehensive review of the indications and procedural recommendations for performing TEVAR based on current evidence in the literature. Additionally, the article guides the readers through step-by-step practical considerations, from choosing the optimal graft to insuring its ideal deployment in type B dissection, as well as providing advice on how to handle a variety of procedure-related complications. |
| Databáze: | OpenAIRE |
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