Emerging evidence supports the use of both best medical therapy and thoracic endovascular aortic repair (TEVAR) for both chronic and acute uncomplicated type B aortic dissections.
Does thoracic endovascular aortic repair (TEVAR) plus best medical therapy improve outcomes compared to medical management alone in patients with uncomplicated type B aortic dissection?
Emerging evidence suggests that adding TEVAR to best medical therapy may be beneficial for uncomplicated type B aortic dissections, challenging the traditional approach of medical management alone.
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.
Cooper et al. (2016) conducted a review in Uncomplicated type B aortic dissection. Thoracic endovascular aortic repair (TEVAR) and best medical therapy vs. Medical management alone was evaluated. Emerging evidence supports the use of both best medical therapy and thoracic endovascular aortic repair (TEVAR) for both chronic and acute uncomplicated type B aortic dissections.