Indication, timing and results of endovascular treatment of type B dissection.
Aortic dissection is an uncommon but a highly lethal condition. Dissection of the ascending aorta is associated with a mortality rate of 1-2% per hour within the first 24h and should be managed by an open surgery. An uncomplicated, acute, type B dissection, which should be treated medically, is less frequently lethal, with survival rates of 84% within 1 year. Unfortunately, long-term outcome of medical therapy alone is suboptimal, with a reported 30-50% mortality rate at 5 years and a delayed expansion of the false lumen in 20-50% of patients at 4 years. In this setting, endovascular treatment should be considered when the aortic diameter exceeds 55-60mm, in case of uncontrolled pain, blood pressure and rapid growth of the dissecting aneurysm (>1cm per year). About 30-42% of acute, type B aortic dissections are complicated, as evidenced by haemodynamic instability or peripheral vascular ischaemia with a mortality rate of 50-85% if not treated properly. In this scenario, stent-graft repair is an attractive alternative to surgical repair for correcting ischaemic complications. The long-term therapy of patients with aortic dissection includes aggressive medical therapy, follow-up visits and serial imaging.
Akin
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Department of Medicine, Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany.
Kische
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Ince
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Nienaber
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D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000784:Aortic Dissection / Q000145:classification / Q000401:mortality / Q000628:therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000401:mortality / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D002908:Chronic Disease; D006801:Humans; D015607:Stents; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D014665:Vasodilator Agents