Treatment Approaches for Type B Aortic Dissection What

Treatment Approaches for Type B Aortic Dissection: What is the Best Option? Abdullah A. Alfawaz, MD, FRCSC Vascular Surgery Medstar Washington Hospital Center

Abdullah A. Alfawaz, MD I have no relevant financial relationships

Aortic Dissection

Acute Type B Aortic Dissection • What is the most widely adopted treatment algorithm?

Acute Complicated TBAD • Open Surgery Vs TEVAR ?

Acute uncomplicated TBAD • Why Medical Therapy ?

Acute Uncomplicated TBAD • Medical therapy Vs TEVAR – Intermediate and long term results

Cumulative Clinical Results: Year 0 through Year 5 46. 1% 19. 1% 27. 0% 19. 3% 11. 1% 6. 9% 12. 4% Clinical Evidence INSTEAD XL: Key Results

Acute uncomplicated TBAD • Which patients are at high risk? – Who should we treat?

• Intimal Tears ( High Risk Factors) – Patent primary tear site in thorax – One entry tear – Entry Tear >10 mm All related to pressurization of FL.

Possible high risk groups: • • False Lumen Size (>22 mm) and Patency Ulcer like projections Aortic Diameter > 40 mm Intimal tear characteristics (single tear, >10 mm)

Acute uncomplicated TBAD • Future considerations – TEVAR for all acute TBAD?

Acute TBAD • Suggested new algorithm ?

Type B Dissection Complicated Uncomplicated Risk TEVAR age, comorbidities High Medical Management Low High Risk Characteristics TEVAR/adjuncts

Thank you.