title: Update in the management of type B aortic dissection.
abstract: Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature.
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA fnauta@umich.edu.com foekenauta@gmail.com.
authors.forename: Foeke Jh
authors.initials: FJ
authors.lastname: Nauta
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy.
authors.forename: Arnoud V
authors.initials: AV
authors.lastname: Kamman
authors.affiliation: Vascular Surgery Department, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Vascular Surgery Department, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Joost A
authors.initials: JA
authors.lastname: van Herwaarden
authors.affiliation: Department of Cardiac Surgery, University of Michigan, USA.
authors.forename: Himanshu J
authors.initials: HJ
authors.lastname: Patel
authors.affiliation: Departments of Biomedical Engineering and Surgery, University of Michigan, USA.
authors.forename: C Alberto
authors.initials: CA
authors.lastname: Figueroa
authors.affiliation: Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: IRAD; TEVAR; management; optimal medical treatment; surgery; type B aortic dissection (TBAD)