Nauta Foeke Jh, Trimarchi Santi, Kamman Arnoud V, Moll Frans L, van Herwaarden Joost A, Patel Himanshu J, Figueroa C Alberto, Eagle Kim A, Froehlich James B
Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA
Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy.
Vasc Med. 2016 Jun;21(3):251-63. doi: 10.1177/1358863X16642318. Epub 2016 Apr 11.
Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature.
B型主动脉夹层（TBAD）是一种危及生命的主动脉疾病。初始治疗目标是通过降低心率和血压来预防主动脉破裂、夹层扩展及症状。无并发症的TBAD患者需要及时的药物治疗，以防止在后续随访期间主动脉扩张或破裂。有并发症的TBAD患者需要立即进行侵入性治疗，以防止因破裂或灌注不良导致的死亡或损伤。诊断和治疗方面的最新进展已大幅降低了与TBAD相关的死亡率。特别是，胸主动脉覆膜支架的引入已将治疗方式从外科手术转变为血管腔内修复，使复杂TBAD患者的早期生存率提高了四倍。此外，除了最佳药物治疗外，现在一些无并发症的TBAD患者也考虑进行血管腔内修复。对于更具挑战性的累及主动脉弓的主动脉夹层患者，结合开放手术和血管腔内修复的杂交手术方法已取得了有前景的结果。无论选择何种治疗策略，除了密切的影像学监测外，所有TBAD患者都应进行严格的降压控制。覆膜支架设计、药物治疗、手术和杂交技术、影像学及基因筛查等未来的发展可能会进一步改善TBAD患者的治疗效果。我们基于文献中的现有证据对推荐的治疗策略进行了全面综述。
