Abstract
Background: Acute type B aortic dissection (TBAD) is a rare condition
that can be divided into complicated (CoTBAD) and uncomplicated
(UnCoTBAD) based on certain presenting clinical and radiological
features, with UnCoTBAD constituting the majority of TBAD cases. The
classification of TBAD directly affects the treatment pathway taken,
however, there remains confusion as to exactly what differentiates
complicated from uncomplicated TBAD. Aims: The scope of this review is
to delineate the literature defining the intervention parameters for
UnCoTBAD. Methods: A comprehensive literature search was conducted using
multiple electronic databases including PubMed, Scopus, and EMBASE to
collate and summarize all research evidence on intervention parameters
and protocols for UnCoTBAD. Results: A TBAD without evidence of
malperfusion or rupture might be classified as uncomplicated but there
remains a subgroup who might exhibit high-risk features. Two clinical
features representative of “high risk” are refractory pain and
persistent hypertension. First line treatment for CoTBAD is TEVAR, and
whilst this has also proven its safety and effectiveness in UnCoTBAD, it
is still being managed conservatively. However, TBAD is a dynamic
pathology and a significant proportion of UnCoTBADs can progress to
become complicated, thus necessitating more complex intervention. While
the “high risk” UnCoTBAD do benefit the most from TEVAR, yet, the
defining parameters are still debatable as this benefit can be extended
to a wider UnCoTBAD population. Conclusion: Uncomplicated TBAD remains a
misnomer as it is frequently representative of a complex ongoing disease
process requiring very close monitoring in a critical care setting. A
clear diagnostic pathway may improve decision making following a
diagnosis of UnCoTBAD. Choice of treatment still predominantly depends
on when an equilibrium might be reached where the risks of TEVAR
outweigh the natural history of the dissection in both the short- and
long-term.