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Current Opinion in Cardiology:
Diseases of the aorta, pulmonary and peripheral vessels

Endovascular stent-graft placement for complications of acute type B aortic dissection

Eggebrecht, Holgera; Lönn, Larsb; Herold, Ulfc; Breuckmann, Frankc; Leyh, Rainerc; Jakob, Heinz Gc; Erbel, Raimunda

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Abstract

Purpose of review: To review the concepts and current clinical results of endovascular stent-graft placement for acute complicated type B aortic dissection.

Recent findings: The optimal treatment for patients with dissections confined to the descending aorta (Stanford type B-AD) remains a matter of debate. Usually, antihypertensive medical therapy with strict blood pressure lowering below 135/80 mm Hg represents the first choice for patients with uncomplicated type B-AD. Patients with acute complicated type B-AD remain a major therapeutic challenge because surgery of the descending aorta is still associated with high morbidity and mortality. In 1999, endovascular stent-graft placement was introduced as a novel, less invasive treatment option for patients with type B aortic dissection. Current indications include acute (contained) aortic rupture, symptomatic ischemic branch vessel involvement, early aortic expansion, or unrelenting pain. So far, few studies on stent-graft placement in patients with acute complicated aortic dissection have been published reporting an early mortality between 0 and ∼20%.

Summary: To date, there is limited experience with endovascular stent-graft placement for acute complicated type B aortic dissection demonstrating its feasibility and life-saving potential. The endovascular approach can avoid the major trauma of open surgery and should help to get patients out of the acute life-threatening phase of the disease; however, long-term results are needed to assess the durability of this treatment.

© 2005 Lippincott Williams & Wilkins, Inc.

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