Behandlungsstrategien der chronischen Typ-B-Aortendissektion

Background: Chronic Type B aortic dissection is a complex disease that needs individual treatment strategies and different considerations than therapy of acute or subacute Type B aortic dissection. Indications for therapy are mainly derived from persistent false lumen perfusion with aneurysm formation. Another challenge for the treatment of chronic Type B aortic dissection is the increasing rigidity and thickness of the dissection membrane, which reduces the aortic remodeling capacity. Objective: This article gives an overview of chronic Type B aortic dissection and summarizes current treatment strategies in regard to conservative, open surgical and especially endovascular approaches. Material and methods: Evaluation of the current literature with respect to treatment strategies for chronic Type B aortic dissection as well as descriptions of new endovascular techniques. Results: Endovascular techniques are becoming more important for the treatment of chronic Type B aortic dissection, especially in multimorbid patients. False lumen occlusion plays an important role in treatment success. Conclusion: Chronic Type B aortic dissection is a challenging disease as the pathology is associated with several features which make standard thoracic endovascular aortic repair (TEVAR) procedures barely sufficient. The rapid development in endovascular techniques provides new directions for the treatment of this disease.