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Outcome and Complications of Type B Aortic Dissection Matt Thompson

Outcome and Complications of Type B Aortic Dissection Matt Thompson St George’s Vascular Institute, London. Changing Management Algorithm. Tsai et al Circulation 2005. Temporal Classification. Acute < 14 days Chronic > 14 days Sub-acute: 2-6 weeks. Acute Type B Thoracic Dissection.

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Outcome and Complications of Type B Aortic Dissection Matt Thompson

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  1. Outcome and Complications of Type B Aortic Dissection Matt Thompson St George’s Vascular Institute, London

  2. Changing Management Algorithm

  3. Tsai et al Circulation 2005

  4. Temporal Classification • Acute < 14 days • Chronic > 14 days • Sub-acute: 2-6 weeks

  5. Acute Type B Thoracic Dissection • Uncomplicated • Complicated

  6. Acute Type B Thoracic Dissection • Uncomplicated • Complicated • Rupture • Impending rupture (unremitting pain / hypertension) • Visceral ischaemia • Limb ischaemia

  7. Suzuki et al Circulation 2003

  8. Prevent Death in Acute Setting • 159 patients acute Type B dissection • Default medical management Dp / Dt • Complicated dissection 47% - mortality 18% • Uncomplicated dissection 53% - mortality 1.2% Estera et al Ann Thorac Surg 2007

  9. 100 Acute Type B dissection Chronic Type B dissection 90 80 Survival (%) 70 60 50 0 6 12 18 24 30 36 42 48 54 60 66 72 Time (months) Endovascular Treatment of Type B Dissection - Survival

  10. Chronic Type B Thoracic Dissection • Uncomplicated • Complicated

  11. Chronic Type B Thoracic Dissection • Uncomplicated • Complicated • Rupture / end organ ischaemia • Retrograde Type A dissection • Aortic dilatation > 6cm

  12. Long Term Prospective Data – Type B • 66 patients Type B – no surgical intervention • 82% remained free of dissection related death 10y • 14% died from aortic disease • 7.5% Type A dissection • 15% exceeded 6 cm Winnerkvist et al EJVES 2006

  13. Mortality Following Endovascular Repair Nienaber – Veith Symposium 2006

  14. Factors Predicting Expansion Soong et al JACC 2007

  15. Indications for Intervention • Acute - complicated • Chronic - complicated / dilated • Sub-acute - sub group??

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