Uncomplicated Type B Dissection

● When to Intervene ?

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Pr JP Becquemin Institut Vasculaire Paris Est

HPPE Champigny sur Marne France

Disclosure

Speaker name: Becquemin

I do not have any potential conflict of interest

Disclosure

Speaker name: Becquemin

I do not have any potential conflict of interest

Treatment Options

BMT TEVAR Open surgery

UATBD : Mortality / Treatment

Fattori R JACC 2008

10 %

35 %

UATBD : Outcomes Endpoints

• Mortality

• Aortic Events

UATBD : Mortality BMT

One month 11 %One Year 16 %Five Year 20%

Estrera AL Circulation 2006Clough R EJVS : 2018 Shimamoto T JTCS : 2018

UATBD : Outcomes Endpoints

• Mortality

• Aortic Events

UATBD : BMT

2008

UATBD : BMT 2019

Limits of BMT

UATBD : BMT CT scan > 8 yrs

Flap fibrosis

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9165 casesSurvival 1 yr 5 yrBMT 84% 60 %OR 76% 67 %

Tevar 85 % 76 %

RisksOf TEVAR

TEVAR for ATBDEUREC Registry (Eggebrecht H Circulation 2008

33/3074 TEVAR (1.1%)Dissection (17 acute, 10 chronic)20/33 urgent Proximal Bar Stent 79%Mortality 42%

How to select patients for early TEVAR ?

254 patients FU 6,8 year38 % intervention

Recent Advances

• Promote Early False Lumen Thrombosis• Balloon False Lumen Rupture ( Alsac)• Coil embolisation ( Pellenc )• Candy Plug Technique ( Kölbel )

Take Home Message

• UATBD is a life threatening event• TEVAR improves survival and reduces late aortic

events• TEVAR is justified selectively• False lumen occlusion should be obtained• Optimum delay of for intervention 1-3 months

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