Medical Management in Patients with Type B Aortic Dissection

Abstract

Patients with type B aortic dissection are treated medically unless they have fatal complications. In the acute phase of medical treatment, it is important to keep the heart rate below 60 and the systolic blood pressure below 120 mmHg. In addition, it is necessary to watch for organ ischemia and enlargement of the dissected aorta. In uncomplicated type B dissections, the early mortality rate with medical therapy is relatively low, but the 5-year mortality rate for patients alive at discharge is reported to be 12–28%. Recently, it has been shown that thoracic endovascular aortic stent graft (TEVAR) within the first year of disease onset can provide effective remodeling of dissected aorta and improve prognosis. However, because of the potential for fatal complications, TEVAR is currently recommended only for high-risk patients, who are more likely to have a poor prognosis. Various studies have been conducted to define high-risk patients and many risk factors have been reported. The future challenge is to determine the indication of preemptive TEVAR through accurate risk stratification to improve the prognosis of patients with type B aortic dissection.