Aortic Surgery 
Aortic Dissection – Type B
The traditional therapy for type B aortic dissections is aggressive control of blood pressure, with the hope the dissection will not progress. Surgery is generally reserved for patients with complications including malperfusion syndrome or active hemorrhage. Open surgical repair is often associated with unacceptably high risks of paralysis, lung dysfunction, and fatal hemorrhage. Medical therapy (blood pressure and pain control) provides palliative care, but does not protect the patient from the later development of large aneurysms, kidney dysfunction, and death from aortic complications.
With endovascular stent grafting clearly established as a therapy for other aortic aneurysms, minimally invasive repair is now evolving as a treatment for type B aortic dissection. The Aortic Surgery Program is currently participating in two trials to compare endovascular repair to medical management. Two fabric covered metal stents are under study, the Medtronic Talent™ Stent Graft and the GORE TAG® Thoracic Endoprosthesis (for the descending thoracic aorta). Inserted through a catheter in the groin, the devices close the dissected aorta and effectively redirect the flow of blood. Patients receiving the stents in these trials receive maximal medical therapy as well. The Aortic Surgery Program is the largest center north of Philadelphia to participate in these trials.
"Patients have done exceptionally well so far," according to Dr. Stewart, who performs the endovascular procedures in collaboration with Drs. James McKinsey from Vascular Surgery and Drs. Williams and Gray, from Interventional Cardiology. "This treatment will potentially offer people improved survival, with a decreased incidence of complications than those associated with medical management and surgery," he says.
Read about aortic dissection.
