title: Diagnosis and treatment of uncomplicated type B aortic dissection.
abstract: A type B dissection involves the aorta distal to the subclavian artery, and accounts for 25-40% of aortic dissections. Approximately 75% of these are uncomplicated with no malperfusion or ischemia. Multiple consensus statements recommend thoracic endovascular aortic repair (TEVAR) as the treatment of choice for acute complicated type B aortic dissections, while uncomplicated type B dissections are traditionally treated with medical management alone, including strict blood pressure control, as open repairs have a prohibitively high morbidity of up to 31%. However, with medical treatment alone, the morbidity, including aneurysm degeneration of the affected segment, is 30%, and mortality is 10% over 5 years. For both chronic and acute uncomplicated type B aortic dissections, emerging evidence supports the use of both best medical therapy and TEVAR. This paper reviews the current diagnosis and treatment of uncomplicated type B aortic dissections.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Michol
authors.initials: M
authors.lastname: Cooper
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Hicks
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Ratchford
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Maya J
authors.initials: MJ
authors.lastname: Salameh
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA bmalas1@jhmi.edu.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Malas
mesh_terms: D000465:Algorithms; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000266:history / Q000401:mortality / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000266:history / Q000401:mortality / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000266:history / Q000401:mortality; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000266:history / Q000627:therapeutic use*; D019091:Critical Pathways; D057510:Endovascular Procedures / Q000009:adverse effects / Q000266:history / Q000401:mortality; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: aorta; aortic diseases; best medical therapy; thoracic endovascular aortic repair (TEVAR); type B aortic dissection