Role of Endoluminal Techniques in the Management of Acute Type B Aortic Dissection and Intramural Haematoma
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REVIEW
Role of Endoluminal Techniques in the Management of Acute Type B Aortic Dissection and Intramural Haematoma Ajay Chavan1 • Osama Eldergash2 • Rohit Philip Thomas3
Received: 2 June 2020 / Accepted: 11 September 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Twenty-five years ago, optimal medical management was the mainstay of treatment in acute type B aortic dissection (TBAD) and intramural haematoma (IMH), with surgery being reserved for cases with rupture or critical branch vessel ischaemia. Less invasive endoluminal management of TBAD and IMH has developed rapidly over the past two and a half decades, thus changing the treatment algorithm in these patients. Today the focus has shifted to primary management with a combination of endoluminal intervention and optimal medical treatment. The purpose of this article is to describe the various interventional techniques, discuss the indications for intervention, and present the results in the current literature regarding clinical (rupture, branch vessel ischaemia) as well as morphological response (aortic remodelling), complications, and morbidity/mortality associated with endoluminal intervention.
& Ajay Chavan [email protected] Osama Eldergash [email protected] Rohit Philip Thomas [email protected] 1
2
3
Department of Diagnostic and Interventional Radiology, Christliches Krankenhaus Quakenbru¨ck, Danziger Strasse 2, 49610 Quakenbru¨ck, Germany Institute of Diagnostic and Interventional Radiology, Klinikum Oldenburg, Oldenburg, Germany
Keywords TEVAR Stent-graft Balloon fenestration True lumen stenting TBAD IMH
Introduction About 25 years ago, acute uncomplicated type B aortic dissections (TBAD) and intramural haematomas (IMH) distal to the origin of the left subclavian artery were largely managed conservatively with best supportive care, medical regulation of blood pressure, reduction in risk factors such as obesity, smoking and hyperlipidemia and modification of life style. Surgery in the acute phase was resorted to in complicated cases with rupture or impending rupture, persistent therapy refractory pain and/or distal malperfusion. Surgery usually consisted of open replacement of the descending aorta with or without surgical fenestration of the intimal flap. The procedures were associated with high morbidity and mortality. Less invasive endoluminal management of these entities has developed rapidly over the past two and a half decades, thus changing the treatment algorithm in these patients. The purpose of this article is to elaborate upon the role the various endoluminal techniques in the management of acute TBAD and IMH. Fact Sheet Ten most important points with respect to endoluminal management of acute TBAD and IMH 1. Indications for invasive intervention in acute TBAD and IMH are ever increasing
Clinic for Diagnostic and Interventional Radiology, UKGM Marburg, Marburg, Germany
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A. Chavan et a
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