Interdisciplinary Expert Consensus Document on Management of Type B Aortic Dissection

• Published in: Journal of the American College of Cardiology Vol. 61; no. 16; pp. 1661 - 1678
• Main Authors: Fattori, Rossella, MD, Cao, Piergiorgio, MD, De Rango, Paola, MD, Czerny, Martin, MD, Evangelista, Arturo, MD, Nienaber, Christoph, MD, Rousseau, Hervé, MD, Schepens, Marc, MD
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 23-04-2013; Elsevier; Elsevier Limited
• Subjects: Aneurysm, Dissecting - complications; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aneurysms; Aortic Aneurysm - complications; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Biological and medical sciences; Blood and lymphatic vessels; Botulism; Cardiology; Cardiology. Vascular system; Cardiovascular; Confidence intervals; consensus; Coronary vessels; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Dissection; Endovascular Procedures - adverse effects; Endovascular Procedures - methods; endovascular treatment; Heart; Hospitals; Humans; Internal Medicine; Medical sciences; Meta-analysis; Morphology; Mortality; Patients; Studies; Surgery; Survival Rate; Treatment Outcome; type B dissection; computed tomography; magnetic resonance imaging; OR; thoracic endovascular repair; MRI; CI; odds ratio; endovascular treatment; MDCT; consensus; CT; multidetector computed tomography; TEVAR; confidence interval; type B dissection; Arterial disease; Vascular disease; Type; Expert; Aortic dissection; Cardiovascular disease; Circulatory system; Document management; Cardiology; Aortic disease; Consensus
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2012.11.072

An expert multidisciplinary panel in the treatment of type B aortic dissection reviewed available literature to develop treatment algorithms using a consensus method. Data from 63 studies published from 2006 to 2012 were retrieved for a total of 1,548 patients treated medically, 1,706 patients who underwent open surgery, and 3,457 patients who underwent thoracic endovascular repair (TEVAR). For acute (first 2 weeks) type B aortic dissection, the pooled early mortality rate was 6.4% with medical treatment and increased to 10.2% with TEVAR and 17.5% with open surgery, mostly for complicated cases. Limited data for treatment of subacute (2 to 6 weeks after onset) type B aortic dissection showed an early mortality rate of 2.8% with TEVAR. In chronic (after 6 weeks) type B aortic dissection, 5-year survival of 60% to 80% was expected with medical therapy because complications were likely. If interventional treatment was applied, the pooled early mortality rate was 6.6% with TEVAR and 8.0% with open surgery. Medical treatment of uncomplicated acute, subacute, and chronic type B aortic dissection is managed with close image monitoring. Hemodynamic instability, organ malperfusion, increasing periaortic hematoma, and hemorrhagic pleural effusion on imaging identify patients with complicated acute type B aortic dissection requiring urgent aortic repair. Recurrence of symptoms, aortic aneurysmal dilation (>55 mm), or a yearly increase of >4 mm after the acute phase are predictors of adverse outcome and need for delayed aortic repair (“complicated chronic aortic dissections”). The expert panel is aware that this consensus document provides proposal for strategies based on nonrobust evidence for management of type B aortic dissection, and that literature results were largely heterogeneous and should be interpreted cautiously.