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7.4.2. Management of Acute Type B Aortic Dissection
COR LOE
Recommendations
1 B-NR 1. In all patients with uncomplicated acute type B aortic
dissection, medical therapy is recommended as the initial
management strateg y.
1 C-LD 2. In patients with acute type B aortic dissection and rupture or
other complications (Table 27), intervention is recommended.
1 C-EO In patients with rupture, in the presence of suitable anatomy,
endovascular stent grafting, rather than open surgical repair,
is recommended.
2a C-LD In patients with other complications, in the presence of
suitable anatomy, the use of endovascular approaches, rather
than open surgical repair, is reasonable.
2b B-R 3. In patients with uncomplicated acute type B aortic dissection
who have high-risk anatomic features (Table 28), endovascular
management may be considered.
Table 27. Consensus Features of Complicated Acute Type B
Aortic Dissection
Feature Comment
Aortic rupture is can be either free or contained (including
hemothorax, increasing periaortic hematoma, or both;
or mediastinal hematoma) and should be addressed
promptly.
Branch artery occlusion
and malperfusion
Complete or partial occlusion of a major branch, with
or without clinical evidence of ischemia; this includes
visceral, renal, and peripheral arterial branches.
Extension of dissection Extension of the dissection flap either distally or
proximally (ie, retrograde type A dissection)
Aortic enlargement Progressive enlargement of the true, false, or both lumens
while in the acute phase may require prompt intervention.
Intractable pain
Uncontrolled hypertension
