Evidence for and risks of endovascular treatment of asymptomatic acute type B aortic dissection.

Acute aortic dissection is a challenging disease to manage. Type B aortic dissection has traditionally been divided temporally into acute and chronic cases but more recently this classification has been modified to include a sub-acute phase. Computed tomography is the imaging technique used most frequently in diagnosis and management. Active management of blood pressure is essential and should include beta-blockade unless contraindicated. In-hospital outcomes are generally acceptable in patients with medically managed acute uncomplicated type B aortic dissection, with up to 90% of patients surviving to hospital discharge but by 5 years up to 50% of patients are dead with a significant proportion dying from aortic rupture. The aim of endovascular repair is to treat the complications of the dissection, induce aortic remodeling and false lumen thrombosis and it has been shown to result in good long-term outcomes. Stent graft placement however is associated with an incidence of death, stroke, paraplegia and retrograde type A dissection. Some experts now advocate high intensity imaging in the first 14 days to detect development of complications early in the disease course, with planned elective treatment in the subacute phase.