IS Case 173: Aortic dissection, type B
Imaging Sciences URMC 2008
Publication Date: 2009-05-21
Aortic dissection, type B
Please refer to interesting case 69 for aortic dissection classification schema.
To determine the prognosis of type B aortic dissection, Tsai and colleagues searched the International Registry of Acute Aortic Dissection for patients surviving initial hospitalization. Almost 25% of patients died within 3 years . With partial thrombosis of the false lumen, the risk of mortality is 2.7 times that of patients with a completely patent false lumen .
Since there is a high mortality rate associated with surgical repair of aortic dissection involving the aortic arch, medical therapy is advocated. Up to half of patients with chronic type B dissections develop aneurysms one to five years after onset. Chronic type B dissection often causes the false lumen to enlarge and the true lumen to become smaller . Ischemic events can necessitate intervention.
Czermak and colleagues concluded that type B aortic dissections within and as much as 2 cm distal to the origin of the left subclavian artery can be treated with endovascular stent-graft placement . Further study of endovascular intervention for type B aortic dissections has been advocated by multiple authors.
- Cambria RP, Brewster DC, Gertler J, et al. Vascular complications associated with spontaneous aortic dissection. JJ Vasc Surg. 1988 Feb;7(2):199-209. [PMID: 3276932]
- Czermak B, Waldenberger P, Fraedrich G, et al. Treatment of Stanford type B aortic dissection with stent-grafts: preliminary results. Radiology. 2000 Nov;217(2):544-50. [PMID: 11058658]
- Kato M, Matsuda T, Kaneko M, et al. Outcomes of stent-graft treatment of false lumen in aortic dissection. Circulation. 1998 Nov 10;98(19 Suppl):II305-11; discussion II311-2. [PMID: 9852919]
- Tsai T, Evangelista A, Nienaber C, et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007 Jul 26;357(4):349-59. [PMID: 17652650]