Treatment Strategy for Complicated Acute Type B Aortic Dissection in the Thoracic Endovascular Aortic Repair Era

Abstract Our treatment strategy for acute type B aortic dissection (ABAD) included complicated type is as follows. Indications of thoracic endovascular aortic repair (TEVAR) for ABAD are rupture and organ ischemia, and TEVAR has been the 1st line central repair therapy since January 2009 in our institution. At the time of TEVAR for ruptured communicating type ABAD, we usually seal the proximal entry tear and cover the existing range of hematoma at descending aorta. Procedures for ABAD with malperfusion should be changed according to the patient's condition such as branch vessel obstructions either dynamic type or static type. We select TEVAR for ABAD with malperfusion in order to prevent late aortic events as well as treat the dynamic malperfusion. For complicated ABAD patients with poor condition and hemodynamic instability, TEVAR achieving central repair rapidly and less-invasively is considered an advantageous procedure. We usually pay attention how to use TEVAR and how to combine with other therapies for complicated ABAD treatment.