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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 1/2019

01-01-2019 | SPECIAL EDITION

How should we manage type B aortic dissections?

Authors: J. Fleerakkers, M. Schepens

Published in: General Thoracic and Cardiovascular Surgery | Issue 1/2019

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Abstract

Dissection of the descending aorta is a serious and potentially lethal event. Treatment options consist of medical therapy, open surgical replacement of the affected aorta and thoracic endovascular repair. In acute cases, medical treatment is started initially. When complicated, endovascular repair is generally considered as first choice treatment, except for connective tissue disorders where open surgery remains the standard. In stable, uncomplicated patients with risk factors for future aortic growth pre-emptive endovascular repair should be considered in the sub-acute phase of the dissection. The treatment strategy in chronic dissections is somewhat debated. Long-term results and aortic remodeling of endovascular repair are disappointing and open surgery remains the standard.
Literature
1.
Debakey ME, Henley WS, Cooley DA, et al. Surgical management of dissecting aneurysm of the aorta. J Thorac Cardiovasc Surg. 1965;49:130–49.PubMed
2.
Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg. 1970;10:237–47.CrossRefPubMed
3.
4.
Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med. 2013;126(8):730.e19–24.CrossRefPubMed
5.
Steuer J, Björck M, Mayer D, et al. Distinction between acute and chronic type B aortic dissection: is there a sub-acute phase? Eur J Vasc Endovasc Surg. 2013;45(6):627–31.CrossRefPubMed
6.
Kusagawa H, Shimono T, Ishida M, et al. Changes in false lumen after transluminal stent-graft placement in aortic dissections. Circulation. 2005;111:2951–7.CrossRefPubMed
7.
Svensson LG, Kouchoukos NT, Miller DC. Expert Consensus Document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg. 2008;85:S1–41.CrossRefPubMed
8.
Kinoshita H, Fujimoto E, Arase H, et al. Efficacy and optimal timing of endovascular treatment for type B aortic dissection. Ann Vasc Dis. 2015;8(4):307–13.CrossRefPubMedPubMedCentral
9.
Rodriguez JA, Olsen DM, Lucas L, et al. Aortic remodeling after endografting of thoracoabdominal aortic dissection. J Vasc Surg. 2008;47:1188–94.CrossRefPubMed
10.
Desai ND, Gottret J, Szeto WY, et al. Impact of timing on major complications after thoracic endovascular aortic repair for acute type B aortic dissection. J Thorac Cardiovasc Surg. 2015;149:s151–6.CrossRefPubMed
11.
12.
Trimarchi S, Eagle KA, Nienaber CA, et al. Importance of refractory pain and hypertension in acute type B aortic dissection: insights from the international registry of acute aortic dissection. Circulation. 2010;122:1283–9.CrossRef
13.
Afifi RA, Sandhu HK, Leake SS, et al. Outcomes of patients with acute type B (Debakey type III) aortic dissection: a 13-year single-center experience. Circulation. 2015;132:748–54.CrossRefPubMedPubMedCentral
14.
Augoustides JG, Szeto WY, Woo EY, et al. The complications of uncomplicated acute type-b dissection: the introduction of the Penn Classification. J Cardiothorac Vasc Anesth. 2012;26(6):1139–44.CrossRefPubMed
15.
Diehm F, Vermassen F, van Sambeek MR, On behalf of the DEFINE Investigators. Standardized definitions and clinical endpoints in trials investigating endovascular repair of aortic dissections. Eur J Vasc Endovasc Surg. 2013;46(6):645–50.CrossRefPubMed
16.
Dake MD, Thompson M, van Sambeek M, et al. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. Eur J Vasc Endovasc Surg. 2013;46(2):175–90.CrossRefPubMed
17.
Erbel R, Aboyans V, Boileau C et al. The task force for the diagnosis and treatment of aortic diseases of the european society of cardiology. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014;35(41):2873–926.CrossRefPubMed
18.
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121(13):e266–369.PubMed
19.
Suzuki T, Isselbacher EM, Nienaber CA, et al. Type-selective benefits of medications in treatment of acute aortic dissection (from the international registry of acute aortic dissection). Am J Cardiol. 2012;109:122–7.CrossRefPubMed
20.
van Bogerijen GH, Tolenaar JL, Rampoldi V, et al. Predictors of aortic growth in uncomplicated type B aortic dissection. J Vasc Surg. 2014;59:1134–43.CrossRefPubMed
21.
Genoni M, Paul M, Jenni R, et al. Chronic beta-blocker therapy improves outcome and reduces treatment costs in chronic type B aortic dissections. Eur J Cardiothorac Surg. 2001;19:606–10.CrossRefPubMed
22.
Kodama K, Nishigami K, Sakamoto T, et al. Tight heart rate control reduces secondary adverse events in patients with type B acute aortic dissection. Circulation. 2008;118(suppl1):s167–70.CrossRefPubMed
23.
Takeshita S, Sakamoto S, Kitada S, et al. Angiotensin-converting enzyme inhibitors reduce long-term aortic events in patients with acute type B aortic dissection. Circ J. 2008;72:1758–61.CrossRefPubMed
24.
Luebke T, Brunkwall J. Type B aortic dissection: a review of prognostic factors and meta-analysis of treatment options. Aorta. 2014;2(6):265–78.CrossRefPubMed
25.
Brunkwall J, Kasprzak P, Verhoeven E, et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg. 2014;48(3):285–91.CrossRefPubMed
26.
Fattori R, Montgomery D, Lovato L, et al. Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc Interv. 2013;6(8):876–82.CrossRefPubMed
27.
Nienaber CA, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6(4):407–16.CrossRef
28.
Durham CA, Aranson NJ, Erqul EA, et al. Aneurysmal degeneration of the thoracoabdominal aorta after medical management of type B aortic dissections. J Vasc Surg. 2015;62(4):900–6.CrossRefPubMed
29.
Erbel R, Oelert H, Meyer J, et al. Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography. Circulation. 1993;87:1604–15.CrossRefPubMed
30.
Tolenaar JL, van Keulen JW, Jonker FH, et al. Morphologic predictors of aortic dilatation in type B aortic dissection. J Vasc Surg. 2013;58(5):1220–5.CrossRefPubMed
31.
Sueyoshi E, Sakamoto I, Uetani M. Growth rate of affected aorta in patients with type B partially closed aortic dissection. Ann Thorac Surg. 2009;88(4):1251–7.CrossRefPubMed
32.
Bernard Y, Zimmermann H, Chocron S, et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol. 2001;87(12):1378–82.CrossRefPubMed
33.
Tsai TT, Evangelista A, Nienaber CA, et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007;357(4):349–59.CrossRefPubMed
34.
Sueyoshi E, Nagayama H, Hayashida T, Sakamoto I, Uetani M. Fate of aorta and clinical outcomes in patients with chronic type B aortic dissection: over 20-year experience. J Cardiovasc Surg. 2014;55(2):247–55.
35.
Nienaber CA, Rousseau H, Eggebrecht H, et al. Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt grafts in Aortic Dissection (INSTEAD) trial. Circulation. 2009;120:2519–28.CrossRefPubMed
36.
Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340(20):1546–52.CrossRefPubMed
37.
Schepens MA. Left heart bypass for thoracoabdominal aortic aneurysm repair: technical aspects. Multimed Man Cardiothorac Surg. 2016;28(39).
38.
Parisi R, Secco GG, Di Eusanio M, Fattori R. Endovascular repair of aortic dissection in marfan syndrome: current status and future perspectives. Diseases. 2015;3:159–66.CrossRefPubMedPubMedCentral
39.
Fattori R, Cao P, De Rango P, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol. 2013;61(16):1661–78.CrossRef
40.
Kamman AV, de Beaufort HW, Van Bogerijen GH, et al. Contemporary management strategies for chronic type B aortic dissections: a systematic review. PLoS One. 2016;11(5):e0154930.CrossRefPubMedPubMedCentral
41.
Tian DH, De Silva RP, Wang T, Yan TD. Open surgical repair for chronic type B aortic dissection: a systematic review. Ann Cardiothorac Surg. 2014;3(4):340–50.PubMedPubMedCentral
42.
Estrera AL, Sandhu H, Afifi RA, et al. Open repair of chronic complicated type B aortic dissection using the open distal technique. Ann Cardiothorac Surg. 2014;3(4):375–84.PubMedPubMedCentral
43.
Andersen ND, Keenan JE, Ganapathi AM, et al. Current management and outcome of chronic type B aortic dissection: results with open and endovascular repair since the advent of thoracic endografting. Ann Cardiothorac Surg. 2014;3(3):264–74.PubMedPubMedCentral
44.
Sellke F, Ruel M. In: Townsend CM, editor. Atlas of cardiac surgical techniques, Chapter 20, Type B, Aortic Dissections. Philadelphia: Saunders Elsevier; 2010. p. 282.
45.
Dong ZH, Fu WG, Wang YQ, et al. Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection. Circulation. 2009;119(5):735–41.CrossRefPubMed
46.
Canaud L, Ozdemir BA, Patterson BO, et al. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg. 2014;260(2):389–95.CrossRefPubMed
47.
Fanelli F, Cannavale A, O’Sullivan GJ, et al. Endovascular repair of acute and chronic aortic type B dissections: main factors affecting aortic remodeling and clinical outcome. JACC Cardiovasc Interv. 2016;9(2):183–91.CrossRefPubMed
48.
Nienaber CA, Kische S, Zeller T, et al. Provisional extension to induce complete attachment after stent-graft placement in type B aortic dissection: the PETTICOAT concept. J Endovasc Ther. 2006;13(6):738–46.CrossRefPubMed
49.
Patterson BO, Cobb RJ, Karthikesalingam A, et al. A systematic review of aortic remodeling after endovascular repair of type B aortic dissection: methods and outcomes. Ann Thorac Surg. 2014;97:588–95.CrossRefPubMed
50.
Kang WC, Greenberg RK, Mastracci TM, et al. Endovascular repair of complicated chronic distal aortic dissections: intermediate outcomes and complications. J Thorac Cardiovasc Surg. 2011;142:1074–83.CrossRefPubMed
51.
Hughes CG, Ganapathi AM, Keenan JE, et al. Thoracic endovascular aortic repair for chronic Debakey IIIb aortic dissection. Ann Thorac Surg. 2014;98(6):2092–8.CrossRefPubMedPubMedCentral
52.
Patterson BO, Holt P, Nienaber CA, et al. Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta. Report from the Medtronic Thoracic Endovascular Registry (MOTHER) Database. Circulation. 2013;127:24–32.CrossRefPubMed
53.
The VIRTUE Registry Investigators. Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE Registry. Eur J Vasc Endovasc Surg. 2014;48(4):363–71.CrossRef
54.
Jang H, Kim MD, Kim GM, et al. Risk factors for stent graft-induced new entry after thoracic endovascular aortic repair for Stanford type B aortic dissection. J Vasc Surg. 2017;65(3):676–85.CrossRefPubMed
Metadata
Title
How should we manage type B aortic dissections?
Authors
J. Fleerakkers
M. Schepens
Publication date
01-01-2019
Publisher
Springer Japan
Published in
General Thoracic and Cardiovascular Surgery / Issue 1/2019
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-017-0818-5

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