Page 6 - Virtual Vascular Vol 16

Chronic Type B Dissection

Incidental finding of a chronic type B dissection in a 45-year
old man. He is completely asymptomatic. There is a large
entry tear in the distal arch feeding into a patent false lumen.
The maximum diameter of the aorta is 43mm. The dissection
stops above the SMA>

There is no clear evidence of whether this sort of uncompli-
cated, chronic type B dissection should be treated with TEVAR
before it reaches the threshold of 6mm. Theoretically early
treatment may promote thrombosis of the false lumen and

prevent expansion, but there is a small risk of intraoperative
complications (stroke, retrograde dissection). Long term
remodelling potential is also less with chronic aneurysmal
aorta. This has to be balanced with the risk of future expan-
sion and the risks of subsequent treatment.

6 This patient chose to have surveillance for the time being.