Guidelines Address Management of Type B Aortic Dissection

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by Healthday

Stepwise approach recommended for evaluation, treatment of TBAD followed by close clinical surveillance

THURSDAY, Feb. 3, 2022 (HealthDay News) — In clinical practice guidelines issued by the Society of Thoracic Surgeons and American Association for Thoracic Surgery and published online Jan. 25 in the Annals of Thoracic Surgery and the Journal of Thoracic and Cardiovascular Surgery, recommendations are presented for the management of type B aortic dissection (TBAD).

Thomas E. MacGillivray, M.D., from the Houston Methodist DeBakey Heart and Vascular Center, and colleagues reviewed the current data and provided recommendations on management of TBAD.

The authors recommend use of a stepwise approach to the evaluation and treatment of TBAD, followed by close clinical surveillance. For patients with uncomplicated TBAD, the recommended treatment remains optimal medical therapy (OMT). For complicated hyperacute, acute, or subacute TBADs and favorable anatomy, thoracic endovascular aortic repair (TEVAR) is indicated. In patients with connective tissue disorders who have TBAD and progression of disease despite OMT, open surgical repair is reasonable over TEVAR as a more durable treatment. If TEVAR coverage obstructs antegrade left subclavian artery (LSA) flow, the authors recommend revascularization of the LSA to reduce the risk of spinal cord ischemia. For patients with chronic TBAD with indications for intervention, open surgical repair should be considered, unless comorbidities are prohibitive.

“We expect this guideline to improve the quality of care of patients with TBAD by providing surgeons the most up-to-date summary of when and how to effectively use which therapies, whether open surgery, endovascular therapy, or a combination of the two over the lifetime of the patient,” a coauthor said in a statement.

Several authors disclosed financial ties to the biopharmaceutical industry.

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