Malperfusion Syndrome in Type B Aortic Dissection: Role of the Endovascular Procedures

The optimal treatment strategy for type B aortic dissec-tion remains controversial. Advances in surgical tech-niques and medical therapy resulted in improved prog-nosis for proximal dissection over the years, whereas nosubstantial progression has emerged in management oftype B aortic dissection (AD) (1-4). Because of the highmorbidity and mortality rates following surgery of thedescending aorta, medical treatment is generally advo-cated for uncomplicated cases (4-7). However, about30% of acute type B dissections at clinical presentationare complicated by hemodynamic instability or periph-eral vascular ischemia with a high risk of mortality, ifuntreated (1-3, 7-8). Recently, endovascular techniqueshave provided additional opportunities in the treatmentof descending aortic diseases. Initial studies demonstrat-ed technical feasibility of endovascular approaches inaortic aneurysm and type B dissection, opening a newattractive approach in the difficult scenario of acute aor-tic syndromes and in management of its complications.

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