Type B Dissection with Malperfusion

Author: Benjamin Starnes, MD; Edward Verrier, MD
Institution: University of Washington
Date Reviewed: July 2014
Learning Domain: Adult Cardiac Surgery
Learning Objective: Type B Dissection; Great Vessel Disease
PowerPoint File: Type B Dissection with Malperfusion

Discussion Points for Conference

• Evidence for Mal-perfusion
• Timing / Indications  for surgery
• Endovascular approaches
  • Role of Fenestration
  • Role of stenting true lumen
  • Role Femoral artery to Femoral artery Bypass
• ? Will remodeling occur?
• Expected outcomes
• Follow up planning

Learning Points

• The management of Type B dissections is evolving
• Malperfusion increases risks
• Endovascular options are more commonly being used
  • Stenting true lumen
  • Fenestration
  • Complex endografting
• Levels of Evidence are low
• Acute and chronic remodeling of the descending aorta may occur. 
• Prospective randomized trials do not exist