Page 23 - Virtual Vascular Vol 2 Sep 2020-f

Post-operative Duplex scan showed patent left subclavian

artery with antegrade flow in the subclavian artery

restored. The patient reported no further dizziness or left

arm claudication afterwards. Stanford Type B Aortic Dissection

with Aortic Rupture

• An aortic dissection occurs when blood penetrates the intima and enters

the media, splitting the inner and the outer part of the media. This can

propagate along the length of the aorta for a variable distance forward
(retrograde dissection) or downwards (antegrade dissection).

• Stanford Type B aortic dissection begins beyond the brachiocephalic

vessel, and spares the ascending aorta. Acute dissection occurs less than

2 week’s history.

• Uncomplicated Type B aortic dissection should be observed closely in

HDU or CCU with stringent blood pressure control, and early threshold to
intervene (endovascular or open surgery) if patients deteriorate. All

patients should have reassessment CT scans.

• Indications of urgent treatment (endovascular or open) are complicated

Type B Aortic dissection with rupture, end-organ mal-perfusion, rapid

aortic dilatation, or persistent hypertension and pain.

• The principle of endovascular treatment is to cover the primary tear with
a stent graft , to decrease pressure and encourage thrombosis in false

lumen. End organ vessels may need to be stented open in selective cases.

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