Current evidence for thoracic aorta type B dissection management

Vascular ◽  
2013 ◽  
Vol 22 (6) ◽  
pp. 439-447 ◽  
Author(s):  
Laura Capoccia ◽  
Vicente Riambau
Keyword(s):  
Aortic Dissection ◽  
Current Evidence ◽  
Acute Type ◽  
Type B ◽  
Chronic Complications ◽  
The Poor ◽  
Time Period ◽  
Type B Dissection ◽  
Long Term Prognosis

Aortic dissection is a devastating cardiovascular condition and represents the most common aortic emergency. Outcome is determined by the type and extent of dissection and the presence of associated complications requiring early diagnosis and treatment. Aortic dissection is defined as acute within 14 days from onset and chronic after that time period. The natural course of type B dissection is determined by 2 elements, early and chronic complications. An uncomplicated acute type B dissection is less frequently lethal but it is not totally benign. Some peculiar issues must be taken into account, such as the high probability of complications development in a dissected aorta and the poor long-term prognosis on medical treatment alone. Then, it would be helpful to identify which patients with uncomplicated type B dissection will have a poorest aortic prognosis over time in order to apply an early intervention.

P2787Gender differences in acute type B aortic dissection

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Chatani ◽  
R Murai ◽  
Y Kawase ◽  
T Tada ◽  
K Kadota
Keyword(s):  
Gender Differences ◽  
Aortic Dissection ◽  
Smoking History ◽  
Hospital Death ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Men And Women ◽  
Long Term Prognosis

Abstract Background The incidence of aortic dissection has been reported to be lower in women; however, women have a poor prognosis. Also, the incidence of false lumen thrombosis has been reported to be different between Europe, the United States, and Japan. We aimed to determine gender differences in long-term prognosis of acute type B aortic dissection. Methods We retrospectively reviewed 220 consecutive patients hospitalized for acute type B aortic dissection between January 2012 to December 2017. After exclusion criteria of unknown onset time, >14 days after the onset, in-hospital death, and aortic events requiring additional treatment during hospitalization were applied, 186 patients were analyzed by gender: 133 men and 53 women. The patient background, treatment method, prognosis, and outcome were compared and examined. Results Both the proportions of smoking history and patients receiving oxygen therapy during hospitalization were significantly higher in men (59% vs. 22%, p<0.01; 91% vs. 72%, p<0.01, respectively), whereas that of classical aortic dissection was similar between men and women (41% vs. 32%, p=0.36). The avoidance rate of a composite of all deaths and aortic events 2 years after discharge was similar (hazard ratio, 0.99; 95% confidence interval, 0.52 to 1.59; p=0.966).(Picture1) Picture 1 Conclusion The long-term prognosis of acute type B aortic dissection treated by medical therapy during hospitalization was equivalent in men and women despite gender differences in several background factors.

Ascending Thoracic Aorta Dimension and Outcomes in Acute Type B Dissection (from the International Registry of Acute Aortic Dissection [IRAD])

2011 ◽  
Vol 107 (2) ◽  
pp. 315-320 ◽  
Author(s):  
Anna M. Booher ◽  
Eric M. Isselbacher ◽  
Christoph A. Nienaber ◽  
James B. Froehlich ◽  
Santi Trimarchi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Thoracic Aorta ◽  
Acute Aortic Dissection ◽  
Acute Type ◽  
Type B ◽  
International Registry ◽  
Type B Dissection

Endovascular Repair of Acute Type B Aortic Dissection: Long-Term Follow-Up of True and False Lumen Diameter Changes

2007 ◽  
Vol 83 (3) ◽  
pp. 1059-1066 ◽  
Author(s):  
Maria Schoder ◽  
Martin Czerny ◽  
Manfred Cejna ◽  
Thomas Rand ◽  
Alfred Stadler ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
False Lumen ◽  
Lumen Diameter ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Long Term Follow Up

scholarly journals Review of Studies Reporting the Incidence of Acute Type B Aortic Dissection

Hearts ◽  
2020 ◽  
Vol 1 (3) ◽  
pp. 152-165
Author(s):  
Marcus Brooks
Keyword(s):  
Aortic Dissection ◽  
English Language ◽  
Hospital Admissions ◽  
Road Traffic ◽  
Acute Type ◽  
Type B ◽  
Cross Sectional ◽  
Aortic Replacement ◽  
Type B Dissection

Aortic dissection (AD) causes more deaths each year in the United Kingdom than road traffic collisions. Yet the incidence of AD is not known. The management of acute type B AD (TBAD) is changing, with the greater use of thoracic aortic stent grafts (TEVAR) in treatment and fewer open surgical procedures performed. The study’s aim is to review the worldwide, English language published, literature on acute TBAD incidence and treatment, to report on its strengths and limitations, and better understand changes in incidence over time and between countries. Thirty-one studies were identified that focus on the epidemiology and treatment of TBAD. Eight of these studies report the incidence of acute TBAD as between of 0.5–6.3 per 100,000 person years. Hospital admissions for aortic dissection are reported to be increasing in six studies and stable in one study. The proportion of patients with TBAD operated on varies between studies (range 13% to 76%). Studies identify patient age (median 51–77 years), gender (range 48%–81% male) and prevalence of cardio-vascular risk factors, specifically hypertension, in the populations studied as independent factors influencing aortic dissection incidence. Treatment of acute TBAD remains largely conservative with analgesia, hypertension control and serial cross-sectional imaging (range 24%–87% TBAD medically treated). The use of TEVAR to treat acute AD is increasing worldwide (range 13%–76% TBAD treated with TEVAR). The incidence of TBAD is under-reported due to out of hospital deaths, variable clinical presentation (miss-diagnosis) and coding errors. Importantly for research, the single International Classification of Diseases (ICD) code for aortic dissection, I17.0, does not distinguish between acute, chronic, type A or type B dissection types. Similarly, the OPCS Classification of Interventions and Procedures version 4 (OPCS-4) codes for TEVAR, L27.4 and L28.4, do not distinguish between acute and chronic AD presentation, unlike the codes for open thoracic aortic replacement. Standardised reporting of aortic dissection type, and the urgency of both the initial presentation (acute or chronic) and treatment (emergency, urgent or planned) in future studies would allow more meaningful comparisons between populations.

scholarly journals Arc of Buhler: A lifesaving anatomic variation. A case report

2020 ◽  
Vol 19 ◽  
Author(s):  
Schizas Nikolaos ◽  
Patris Vasilios ◽  
Lama Niki ◽  
Eleftherios Orestis Argyriou ◽  
Kratimenos Theodoros ◽  
...  
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Blood Supply ◽  
Anatomic Variation ◽  
Anatomical Variation ◽  
Celiac Artery ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type B Dissection

Abstract The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).

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