Type B aortic dissection management: A narrative review of guidelines and systematic reviews: Type B aortic dissection management

Type B aortic dissection management

Authors

  • Samir Ghimire Carribean Medical University, Willemstad, Curacao
  • Arman Arghami Cardiovascular Surgery Department, Mayo Clinic, Rochester, Minnesota, USA
  •  Aresha Masood Shah Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • Marium Billoo Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • Rehan Billoo Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • Mohammad Zarenezhad Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
  • Asra Iqbal Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • Somayeh Ahmadnezhad Ramsar Campus, Mazandaran University of Medical sciences, Ramsar, Iran
  • Fatemeh Maleki Department of Emergency Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
  • Behrang Rezvani Kakhki Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • Sayyed Majid Sadrzadeh Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • somayeh mehrpour Department of Anesthesiology and critical care, Qom University of Medical Sciences, Iran
  • Roohie Farzaneh Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • Uzair Yaqoob Department of Neurosurgery, Civil Hospital, SMBBIT, Karachi, Pakistan

DOI:

https://doi.org/10.31661/gmj.v12i.2967

Keywords:

Aortic Dissection, Endovascular Repair, Review, Systematic Review, Meta-analysis

Abstract

Background: Surgical or medical treatment for type B or descending aortic dissections with difficult presentation or stable hemodynamics is debatable. This study aimed to review the type B aortic dissection therapy to assess safety and effectiveness. Materials and Methods: Online databases of PubMed, Science Direct, Web of Science, Cochrane, and Scopus were searched for relevant systematic reviews, guidelines, and meta-analysis studies on the management of type B aortic dissection, up to July 2023. The conclusions were qualitatively synthesized. Results: Best medical therapy (BMT], thoracic aortic endovascular repair (TEVAR), and open surgeries (OS) were management approaches. Hemodynamics classify type B aortic dissection as complex or simple. Both examples reveal decreased in-hospital all-cause mortality with TAVR than OS. Guidelines recommend TEVAR for difficult situations and OS if it fails. Complication analyses favour TEVAR, however left subclavian artery coverage without revascularization increases stroke risk. Studies show Type B aortic dissection is simpler than TEVAR and BMT. Acute or subacute presentation did not affect reintervention rates between treatments. TEVAR had a greater early stroke risk than BMT but a decreased long-term aortic-related and all-cause mortality. The best data showed no differences in in-hospital mortality or early re-intervention between regimens. BMT reduced early stroke but increased late all-cause death. Conclusion: In conclusion, addressing Type B aortic dissection is complicated, depending on presentation and hemodynamics. TEVAR is best for difficult patients, however BMT and OS also work. TEVAR may reduce in-hospital mortality but increase early stroke risk.

 

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Published

2023-12-18

How to Cite

Ghimire, S. ., Arghami, A. ., MasoodShah, Aresha., Billoo, M. ., Billoo, R. ., Zarenezhad, M. ., … Yaqoob, U. . (2023). Type B aortic dissection management: A narrative review of guidelines and systematic reviews: Type B aortic dissection management: Type B aortic dissection management. Galen Medical Journal, 12, e2967. https://doi.org/10.31661/gmj.v12i.2967

Issue

Section

Review Article