0900_Shariff.pdf

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1、Current Indications for Management of Type B Aortic DissectionSaadat Shariff,MDAssociate Professor of Cardiothoracic and Vascular SurgeryMontefiore Medical Center/Albert Einstein College of MedicineDISCLOSURECOOK SpeakerGore ConsultantDefinitionsDebakey and Stanford classification significant defici

2、enciesSVS/STS guidelines location of primary entry tear and extent of dissectionTBAD primary entry tear in zones 1 to 11Chronicity ClassificationClassification of Acute TBADLombardi JV et al.J Vasc Surg.2020 Mar;71(3):723-747.Who to treat?Current GuidelinesACC/AHA OMT for uncomplicated TBAD(Class 1)

3、Intervention recommended complicated TBAD(Class 1)Endovascular stent-grafting over open surgical repairESC OMT for uncomplicated TBAD(Class I)Urgent TEVAR for complicated cases(Class I)Consider TEVAR in“uncomplicated”TBAD with high-risk features(Class IIa)SVS/STS OMT for uncomplicated TBAD(Class I)T

4、EVAR for complicated acute,hyperacute,or subacute(Class I)TEVAR may be considered in uncomplicated TBAD with high risk Open surgical repair is reserved for select cases e.g.connective tissue disordersAll Guidelines Initial medical therapy for all acute Type B dissections Urgent intervention for comp

5、lications.TEVAR is regarded as first-line therapy for complicatedComplicated TBADUncomplicated TBADOMTTrend towards OMT+TEVAREarlier intervention may mitigate aneurysmal degenerationHigh riskLombardi JV et al.J Vasc Surg.2020 Mar;71(3):723-747.TEVAR Refractory Pain*Refractory HTN*(on 3 meds w max do

6、se)Readmission*persists for 12h despite max medical therapyTiming of TreatmentSVS/STS Guidelines In patients with acute uncomplicated TBAD with high-risk features,it may be reasonable to consider delaying treatment(beyond 24 hours up to 90 days)with TEVAR to reduce early adverse events and to improv