From the Guidelines
Stanford type B aortic dissection is typically diagnosed based on clinical presentation and imaging studies, and treatment involves medical management for uncomplicated cases, while complicated cases require prompt intervention.
Diagnosis
The diagnosis of Stanford type B aortic dissection is based on clinical features such as aortic rupture, branch artery occlusion and malperfusion, extension of the dissection flap, aortic enlargement, intractable pain, and uncontrolled hypertension 1, 2.
Treatment
- Uncomplicated cases: are usually treated conservatively with medical management, as there is no proven superiority of one particular treatment above another, be it surgical, interventional by stent grafting or medical 3.
- Complicated cases: require prompt intervention, which may include surgical intervention or catheter guided fenestration of the dissection membrane to decompress the true lumen of the abdominal aortic segment 1, 2.
Management
The management of Stanford type B aortic dissection involves decreasing hemodynamic stress in patients with elevated blood pressure, and the definitive management varies according to the location of the dissection 4. Key points to consider in the management of Stanford type B aortic dissection include:
- Aortic rupture: requires prompt intervention to prevent further complications 1, 2.
- Branch artery occlusion and malperfusion: may require intervention to restore blood flow to the affected area 1, 2.
- Extension of the dissection flap: may require prompt intervention to prevent further complications 1, 2.
- Aortic enlargement: may require prompt intervention to prevent further complications 1, 2.
- Intractable pain and uncontrolled hypertension: require prompt management to prevent further complications 1, 2.
From the Research
Diagnosis and Treatment of Stanford Type B Aortic Dissection
The diagnosis and treatment of Stanford type B aortic dissection (TBAD) involve a comprehensive approach to prevent aortic rupture, propagation of the dissection, and symptoms. The initial management goal is to reduce the heart rate and blood pressure through medical therapy 5.
Medical Management
- Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up 5, 6.
- Strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance 5.
Invasive Management
- Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion 5, 7, 6, 8.
- Emergent thoracic endovascular aortic repair (TEVAR) is the golden standard for all complicated type B dissections 7, 6, 8.
- Uncomplicated TBAD with high-risk features should undergo TEVAR in the subacute phase 6.
- Open surgical repair is seldom required and reserved only for select cases, such as chronic post-dissection aneurysms 7, 6.
Endovascular Therapy
- Endovascular therapy for Stanford type B aortic dissection is less invasive and leads to less severe complications and shorter hospital stay compared with traditional surgery 9.
- Endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy 5.
- Hybrid approaches, combining open and endovascular repair, have had promising results for more challenging aortic dissection patients with involvement of the aortic arch 5.