Management of Type B Aortic Dissection

Publication Date: January 24, 2022

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the Society of Thoracic Surgeons for the Management of Type B Aortic Dissection (TBAD).

Overview

Aortic dissection describes a tear in the inner lining of the aorta that allows blood to dissect (flow) into the wall of the aorta. This can stop blood flowing to vital organs.
Throughout this summary, we will use the abbreviations SCI for spinal cord ischemia (inadequate blood supply), TEVAR for thoracic endovascular aortic repair, and TBAD for type B aortic dissection.
Some of the most common causes of aortic dissection are common cardiovascular disease, sustained high blood pressure, smoking, Marfan syndrome, and other congenital cardiovascular conditions.
Symptoms include sudden severe tearing back pain and fainting.
This patient summary focuses on the management of type B aortic dissection.

Diagnosis

The initial assessment must include the blood supply to every threatened organ, especially the spinal cord.
Your general health and any additional medical conditions must be evaluated.
The urgency of the threat will affect how soon surgical repair can begin.

Treatment

There are several treatment choices:
Optimal medical therapy (OMT) without surgery can be considered if your situation is not immediately life-threatening.
- OMT is often added after surgical repair to prevent recurrent dissection.
- OMT includes medications to control blood pressure.
Thoracic endovascular aortic repair (TEVAR) is favored if judged to be effective.
- TEVAR describes inserting a long, thin device into your aorta, usually, through a small incision in the artery in your groin, that can implant a stent (an expandable wire tube) to seal the tear and prevent further damage
Open surgical repair is a major undertaking.
Fenestration describes creating another opening in the inner lining of the aorta so that blood can flow out of the blind pocket created by the initial tear and re-enter its normal channels.
Additional procedures may have to be done to assure that the blood supply to the spinal cord or other organs is preserved or re-established.

Abbreviations

OMT: Optimal Medical Therapy
SCI: Spinal Cord Ischemia
TBAD: Type B Aortic Dissection
TEVAR: Thoracic Endovascular Aortic Repair

Source Citation

MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, et al. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg. 2022;XXX:XX-XX.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.