title: Early and late management of type B aortic dissection.
abstract: The management of type B aortic dissection is undergoing profound changes with timely TEVAR accepted as first-line strategy in the setting of complicated dissection; with recent technological advances and in experienced hands this intervention is considered safe and life-saving. With the ability to remodel the dissected aorta as a result of scaffolding even pre-emptive endovascular treatment is being considered and supported by long-term stability and often prevention of aneurysmal expansion. This insight and a growing number of silent risk conditions (resistant hypertension, partial false lumen thrombosis) may lower the threshold for TEVAR in asymptomatic patients in the subacute phase. In the chronic phase of a type B dissection patients are usually free of symptoms, however, with the expanding false lumen at risk of rupture. Advanced TEVAR options (including branches and fenestrations) are likely to be used more often than open surgical replacement of such aneurysmatic segment of the dissected aorta in that chronic phase. All dissection patients should be offered lifelong surveillance.
authors.affiliation: Department of Cardiology, University Heart Centre Rostock, University of Rostock, Rostock, Germany.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.affiliation: Department of Cardiology, University Heart Centre Rostock, University of Rostock, Rostock, Germany.
authors.forename: Dimitar
authors.initials: D
authors.lastname: Divchev
authors.affiliation: Hospital Dresden-Friedrichstadt, Dresden, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Palisch
authors.affiliation: Cardiovascular Imaging Department, King's College London, London, UK.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Clough
authors.affiliation: Privatklinik Jägerwinkel, Bad Wiessee, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Richartz
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D001019:Aortic Rupture / Q000209:etiology / Q000517:prevention & control*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D002908:Chronic Disease; D051799:Delayed Graft Function; D019468:Disease Management; D006801:Humans; D017063:Outcome Assessment, Health Care; D014057:Tomography, X-Ray Computed / Q000379:methods; D014654:Vascular Patency
keywords: Aorta; Great Vessels and Trauma