Fisiopatología, clínica y diagnóstico de la disección tipo B complicada. Estrategias terapéuticas (original) (raw)
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Manejo endovascular de las complicaciones agudas de la disección aórtica tipo B
Revista médica de Chile, 2010
Endovascular management of acute complications of type b aortic dissection Background: Type B aortic dissection is usually managed by intensive care medical therapy and surgery is reserved for treating the complications that can occur during the evolution of a case. Aim: To assess the endovascular management of acute complications of type B aortic dissection and the closure of the intimal defect and aortic false lumen. Material and Methods: Retrospective analysis of 8 consecutive patients aged 40 to 57 years (seven males) treated for acute complications in the initial episode of a type B aortic dissection between August 2006 and July 2008. Results: Six/eight were known hypertensive patients. The indications for surgery were intractable pain in one, hypertension refractory to treatment in two and distal hypoperfusion in five. Five patients required covering of the left subclavian artery ostium, without need for surgical repair. One patient was subjected to renal angioplasty and stenting. Technical success was achieved in all cases, with complete closure of the proximal aortic tear and thoracic aortic false lumen, although 7 of patients had a persistent distal aortic false lumen. One case had a transient lower limb paraparesis. No patient died. Conclusions: Endovascular treatment is effective in closing the aortic tear as well as the thoracic aortic false lumen in aortic type B dissections with a low complication rate. Due to the high frequency of distal aortic false lumen persistence, it is not a definitive treatment for this condition but it is useful for the acute complications of the initial phase of type B aortic dissection.
Tratamiento endovascular de la disección aórtica tipo B mediante endoprótesis
Revista Medica De Chile, 2008
Endovascular treatment of type B aortic dissection Background: Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery. Aim: To report the results of endovascular treatment of type B aortic dissection. Material and methods: Report of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39% smoked. The diagnosis was confirmed by CAT scan. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography. Results: All procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up period ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak. Conclusion: Endovascular treatment of type B aortic dissection has good immediate and long term results (
Cirugía Cardiovascular, 2014
Ante la ausencia de evidencia científica sólida, un comité de expertos europeos ha publicado en la revista Journal of the American College of Cardiology un documento de consenso sobre el manejo de los diferentes subgrupos de pacientes con disección aórtica tipo B. Este documento está basado en un metaanálisis que recopila toda la experiencia publicada en los últimos años sobre disección aórtica tipo B, incluyendo a más de 6.700 pacientes. A pesar de su mejor pronóstico en fase aguda que la disección aórtica tipo A, la disección aórtica tipo B presenta un mal pronóstico a medio y largo plazo. El manejo limitado al tratamiento médico con control estricto de la presión arterial y el tratamiento de los casos complicados mediante cirugía abierta o técnicas endovasculares está sometido a controversia, especialmente por la disponibilidad y los buenos resultados de las técnicas endovasculares. Este documento pretende apoyar a los cirujanos o médicos que tratan la disección aórtica tipo B, estableciendo algunos algoritmos de manejo. Recogemos en este artículo las conclusiones y los datos fundamentales de este documento de consenso. La aparición posterior de los resultados a 5 años del estudio INSTEAD añaden una fuerte evidencia científica en contra de alguna de las principales conclusiones alcanzadas en este consenso y retan este consenso logrado solamente un año antes.