Drs. Sophia Khan and Rana Afifi Discuss Type B Aortic Dissection Management with Endovascular Today
In a recent article in Endovascular Today, Sophia Khan, MD, assistant professor of vascular surgery and Rana Afifi, MD, associate professor of vascular surgery, discuss the evolving treatment methodologies for acute aortic dissection, specifically type B aortic dissection (TBAD).
With acute aortic dissection being a complex and life-threatening condition, the management and prognosis of TBAD patients historically hinged on complications at the time of initial diagnosis. The latest 2022 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines state that TBAD is categorized as complicated (cTBAD) when complications such as rupture, malperfusion, extension of dissection, progressive enlargement of the true or false lumen, intractable pain, or uncontrolled hypertension exist.
The guidelines recommend intervention, alongside optimal medical treatment, for cTBAD, while uncomplicated TBAD (uTBAD) involves initial management with optimal medical treatment. Notably, the nuanced challenge lies in accurately identifying patients with truly uTBAD, contributing to the ongoing controversy in its management.
Over the past two decades, the landscape of treating complicated TBAD has undergone a transformative shift, with thoracic endovascular aortic repair (TEVAR) emerging as the standard of care due to its superior outcomes compared to open surgical repair. However, the management of uTBAD continues to be a subject of debate. Explore Dr. Khan and Afifi’s thoughts on the topic.