Management of Complicated Type B Aortic Dissection

Immediate Medical Stabilization

• The European Society of Cardiology recommends initiating intravenous beta-blockers immediately, targeting heart rate ≤60 bpm and systolic blood pressure 100-120 mmHg, for patients with type B aortic dissection 1, 3
• The European Society of Cardiology suggests providing adequate pain control to achieve hemodynamic targets and reduce aortic wall stress 1, 2
• Admission to an intensive care unit with invasive arterial line monitoring and continuous three-lead ECG is recommended for patients with type B aortic dissection 1

Classification as Complicated TBAD

• The European Society of Cardiology defines renal malperfusion as a complication requiring emergency intervention in patients with type B aortic dissection 1, 2, 5

Emergency Intervention Strategy

• The European Society of Cardiology recommends TEVAR as the first-line therapy for complicated acute TBAD 1, 2
• Emergency intervention is indicated for any type B dissection with malperfusion (cerebral, mesenteric, lower limb, or renal) 1, 2
• TEVAR has replaced open surgery as first-line treatment due to superior short- and long-term outcomes 5

Post-Intervention Management

• The European Society of Cardiology recommends switching to oral beta-blockers after 24 hours if hemodynamically stable and gastrointestinal function preserved 1, 3
• Follow-up imaging at 1, 6, and 12 months post-operatively, then yearly until fifth post-operative year, is recommended 2
• Lifelong antihypertensive therapy with target blood pressure <135/80 mmHg is recommended 6, 4

Critical Considerations

• Transfer to a high-volume aortic center with multidisciplinary team expertise is recommended if not already at such a facility 7, 3