In Patients with Acute Type B Aortic Dissection, Do Current Operative Therapies Reduce Complications Compared to Medical Management?

Abstract

The management of acute type B aortic dissection (TBAD) has largely been dictated by whether or not the case is “complicated,” meaning symptomatic or extensive such that no intervention would lead to death. Historically, complicated acute TBAD has been managed with operative intervention and uncomplicated acute TBAD has been managed with medical treatment. Acute complicated TBAD left untreated has mortality rates as high as 50 % in the first month. While uncomplicated acute TBAD has good outcomes with medical management in the short-term, long-term outcomes are discouraging with mortality rates approaching 30–50 % at 5 years, largely due to aneurysmal degeneration of the false lumen. Both open and endovascular treatment strategies have a role in both complicated and uncomplicated acute TBAD and the role of endovascular intervention is ever-expanding as research shows favorable short-term outcomes and long-term aortic remodeling.