Type B Aortic Dissection

Type B Aortic Dissection

Traditionally, type B dissections (Dissections beyond the left subclavian artery) are treated conservatively unless one of the following situations is present.

• Aneurysm of pseudolumen.
• Tear or leak of the psudolumen.
• Visceral branch or limb branch involvement causing decrease in perfusion of an organ.

However, persisting pain not responding to conservative treatment is a relative indication for intervention nowadays. Various methods of interventional procedures are attempted to control the primary tear in the intima.

One common interventional method is to stent across the proximal intimal tear. This prevents the blood from entering the pseudo-lumen and eventually blood in the pseudo-lumen gets thrombosed.

Whenever decision is made to treat the type B Dissection conservatively, a close follow up is mandatory. CT Aortogram/MR Aortogram should be performed at 3 months and one year.

Type A Aortic Dissection

Type A Aortic Dissection

As soon as the diagnosis is made, planning of treatment should be started. The extent of dissection, aneurysm formation, presence of rupture and the branch involvement usually dictates the type of surgery.

The commonest scenario is a dissection starting at the ascending aorta just above the level of Right Coronary Artery and extending to variable distance of aorta. The tear usually involves the arch partly or completely. It may even involve one or more of the major arch vessels. But as long as the perfusion to these vessels are intact and there is no aneurysm formation of the pseudolumen, surgical intervention of arch is not indicated. The treatment then would be an Aortic root replacement.

The valve may be replaced or preserved depending on the presence or absence of valve or annulus involvement.

When the arch of aorta is badly damaged or the psuedolumen is aneurysmal in this area, the arch should be addressed during surgery. Depending on the extent of involvement, part (Hemiarch) or entire (Total Arch) arch may be replaced.