From the Guidelines
The best treatment for Type B aortic dissection is typically medical management, particularly for uncomplicated cases, with a focus on aggressive blood pressure control and pain relief, as recommended by the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1.
Key Components of Treatment
- Medical therapy, including pain relief and blood pressure control, is essential for all patients with acute Type B aortic dissection (TBAD) 1.
- Beta-blockers (BBs) should be considered as the first-line medical therapy for patients with acute TBAD, aiming for a systolic blood pressure between 100-120 mmHg and heart rate below 60 beats per minute 1.
- For complicated acute TBAD, emergency intervention is recommended, with thoracic endovascular aortic repair (TEVAR) as the first-line therapy 1.
- In patients with uncomplicated acute TBAD, TEVAR in the subacute phase (between 14 and 90 days) should be considered in selected patients with high-risk features 1.
Treatment Approach
- Initial treatment focuses on aggressive blood pressure control using intravenous beta-blockers, such as labetalol or metoprolol, and additional antihypertensives like nicardipine may be needed 1.
- Pain control with opioid analgesics is essential to reduce discomfort and stress on the aortic wall.
- Long-term management includes lifelong blood pressure control with oral medications, typically beta-blockers and other antihypertensives, regular imaging surveillance with CT or MRI, and lifestyle modifications including smoking cessation and exercise restrictions during the acute phase.
From the Research
Treatment Options for Type B Aortic Dissection
- The current guidelines for treatment of type B aortic dissections recommend immediate anti-impulse medical therapy, with thoracic endovascular aortic repair (TEVAR) being the treatment of choice for most patients with malperfusion or rupture 2.
- For uncomplicated type B aortic dissections, TEVAR may be considered in the subacute phase to reduce the incidence of late aneurysmal degeneration in the ungrafted segments of the thoracoabdominal aorta 2, 3.
- Beta-blockers are commonly used as first-line therapy to decrease aortic wall stress, although there is limited evidence to support their use as the primary treatment for chronic type B aortic dissections 4.
Role of Beta-Blockers in Treatment
- Studies have shown that the use of oral beta-blockers is associated with significant protection against in-hospital mortality and stroke following repair of type B aortic dissections 5.
- The use of intravenous beta-blockers, particularly metoprolol, has also been shown to reduce mortality in patients with type B aortic dissections 5.
- Postoperative beta-blocker use has been associated with improved early aortic remodeling and increased complete false lumen thrombosis after TEVAR for type B aortic dissections 6.
Surgical Intervention
- Open surgical repair is seldom required and is typically reserved for select cases of type B aortic dissections 2.
- TEVAR is a minimally invasive procedure that has been shown to be effective in reducing morbidity and mortality in patients with type B aortic dissections 2, 3.
- The choice of surgical intervention depends on the individual patient's condition and the presence of complications such as malperfusion or rupture 2.