Indication of endovascular treatment of type B aortic dissection - Literature review

Aortic dissection is a cardiovascular event of high mortality if not early diagnosedand properly treated. In Stanford type A aortic dissection, there is the involvementof the ascending aorta, whereas in type B the ascending aorta is not affected. Thetreatment of type A aortic dissection is mainly surgical. The hospital mortality oftype B aortic dissection surgical treatment is approximately 20%, while medicaltherapy is 10%. However, half the patients who are discharged from hospital aftermedical treatment, progress to aortic complications in the following years, and themortality in three to five years may reach 25-50%. In addition, the surgicaltreatment of aortic complications after medical treatment, has also a significantmortality. This way, the endovascular treatment comes up as an interestingalternative of a less invasive treatment for this disease. They presented a mortalityrate lower than 10% with more than 80% success rate of occlusion and thrombosis ofthe false lumen. The INSTEAD TRIAL, which randomized patients with uncomplicated typeB aortic dissection for optimal medical therapy and endovascular treatment inaddition to optimal medical therapy, showed that after three years of follow up,patients who underwent endovascular treatment had lower mortality and aorta-relatedcomplications. Therefore, there is a current tendency to recommend the endovasculartreatment as a standard for the treatment of type B aortic dissection