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Trahanas et al. Vessel Plus 2022;6:49 Vessel Plus
DOI: 10.20517/2574-1209.2021.125

Review Open Access

Management of chronic type B aortic dissection

1
2
1
John M. Trahanas , Omar A. Jarral , Chandler Long , G. Chad Hughes 1
1
Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC 27710,
USA.
2
Department of Surgery, Division of Vascular Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Correspondence to: Dr. Chandler Long, Department of Surgery, Division of Vascular Surgery, Duke University Medical Center,
DUMC Box 3538, Durham, NC 27710, USA. E-mail: chandler.long@duke.edu
How to cite this article: Trahanas JM, Jarral OA, Long C, Hughes GC. Management of chronic type B aortic dissection. Vessel Plus
2022;6:49. https://dx.doi.org/10.20517/2574-1209.2021.125

Received: 29 Sep 2021 First Decision: 7 Feb 2022 Revised: 26 Feb 2022 Accepted: 6 Apr 2022 Published: 1 Sep 2022
Academic Editors: Frank W. Sellke Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

Abstract
The standard of care first-line therapy for uncomplicated acute type B aortic dissection is medical therapy. As a
result, many of these dissections progress to become chronic type B aortic dissections (CTBAD). In the following
manuscript, we will outline the natural history of these lesions and review what constitutes a CTBAD by anatomy
and chronology. We will also describe the long-term medical management and surveillance of these lesions, what
constitutes high-risk features, and when intervention should be considered. Endovascular, open and hybrid
management strategies, potential complications, and subsequently required surveillance will also be discussed.
With proper medical management, surveillance, and intervention, CTBAD can be managed effectively and
downstream morbidity minimized.

Keywords: Type B aortic dissection, chronic aortic dissection, thoracoabdominal aortic dissection, aortopathy

INTRODUCTION
Aortic dissection affects approximately 30 people per million individuals per year . This life-threatening
[1]
event occurs when the intimal lining of the aorta is disrupted, and blood can separate the fibers of the aortic
media, propagating the lesion. Dissections are classified according to the location of the intimal tear and the
affected segments. The prognosis and treatment of these lesions differ depending on the anatomic
classification. The prognosis is also affected by the time since the inciting aortic event, as certain problems
can occur acutely, while different issues arise in the chronic phase. In this manuscript, we will focus on

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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