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Descending Aortic Dissection (Type B) in Nice

Dr. Ilya Khantalin, Vascular Surgeon in the Alpes-Maritimes

Descending Aortic Dissection (Type B)

Dr. Ilya Khantalin in Nice

Descending aortic dissection, also known as Type B aortic dissection, is a serious vascular condition requiring prompt and specialized care. It involves a tear in the inner layer of the aortic wall, creating a false lumen into which blood can flow. This situation is dangerous, as it may lead to complications such as aortic rupture or decreased blood flow to vital organs.

Arterial diseases are now managed using modern techniques validated by the Haute Autorité de Santé (French National Health Authority), favoring innovative approaches and adherence to recognized surgical protocols.

Vascular diseases are classified as Long-Term Illnesses (Affections de Longue Durée – ALD), ensuring 100% coverage by French Social Security.

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Understanding Descending Aortic Dissection (Type B)

Vascular Surgeon in Saint-Laurent-du-Var

Type B aortic dissection occurs when a tear develops in the wall of the descending aorta, typically after the aortic arch. The aorta is the largest blood vessel in the human body, and any alteration in its structure can severely compromise blood supply to the organs. In Type B dissection, the tear affects the descending thoracic aorta and often extends into the abdominal aorta.

Treatment of Descending Aortic Dissection (Type B)

Vascular Surgery Specialist in Saint-Laurent-du-Var

Type B aortic dissection can be triggered by several factors. The main causes include:

  • Uncontrolled high blood pressure, which weakens the aortic wall
  • Connective tissue disorders, such as Marfan syndrome, that impair aortic structure
  • History of aortic surgery or cardiovascular disease
  • Smoking, which damages arterial walls
  • Dyslipidemia

Other risk factors, such as advanced age, family history, and certain infections, may also contribute to the onset of aortic dissection.

Type B aortic dissection often presents with sudden, intense chest pain radiating to the back. Other symptoms may include:

  • Chest and back pain
  • Abdominal or lower back pain
  • Weakness or numbness in the legs
  • Digestive or kidney function issues due to reduced blood flow to those organs
  • Blood pressure discrepancy between the arms

These symptoms vary depending on the dissection’s extent and the organs involved. Immediate medical attention is essential to reduce the risk of complications.

Type B descending aortic dissection is a medical emergency requiring urgent care at a center specializing in cardiovascular pathology.

Medical Treatment

For patients with stable Type B dissection (without acute complications), medical management may be sufficient. The goal is to reduce blood pressure and lower the stress on the aortic wall using medications such as:

  • Beta-blockers, to slow the heart rate and reduce blood pressure
  • Antihypertensives, including ACE inhibitors and angiotensin II receptor blockers (ARBs), to control blood pressure
  • Antiplatelet agents

Close clinical and radiological monitoring is essential in these cases to detect any changes in the dissection.

Endovascular Treatment (TEVAR)

Endovascular treatment of descending aortic dissection, or TEVAR (Thoracic Endovascular Aortic Repair), is recommended for patients with complications or high risk of progression. TEVAR involves placing a stent graft into the dissected portion of the aorta to seal the tear and restore normal blood flow. The stent is introduced through a puncture in the common femoral artery.

TEVAR is less invasive than open surgery and is generally well tolerated, particularly in patients for whom open surgery poses high risks. However, it requires technical expertise and careful postoperative monitoring to prevent complications.

The choice of treatment depends on several factors:

  • The patient’s hemodynamic stability
  • The presence of complications such as rupture, rapid aortic dilation, or organ ischemia
  • The patient’s age and general health status

Medical treatment is indicated for stable dissections without complications, while endovascular repair is preferred for complicated cases.

Follow-up is essential after a Type B aortic dissection, regardless of the treatment used. Goals include:

  • Blood pressure monitoring, to maintain optimal levels
  • Regular imaging, such as CT or MRI scans, to detect dissection progression or complications
  • Management of risk factors, including lifestyle counseling (healthy diet, smoking cessation) and regular cardiac monitoring

The frequency of follow-up visits varies, but a check-up every 6 to 12 months is generally recommended.

While Type B aortic dissection is difficult to prevent entirely, several measures can help reduce the risk:

  • Regular blood pressure monitoring
  • Avoidance of risk factors such as smoking and sedentary lifestyle
  • Cardiovascular screening, especially for individuals with a family history of aortic disease

Type B descending aortic dissection is a serious condition requiring immediate medical attention and long-term follow-up. Treatment decisions are based on thorough assessment of the patient’s condition and the dissection’s progression, with options ranging from medical management to endovascular repair and, in some cases, open surgery.

For further questions or to schedule a consultation, please contact Dr. Ilya Khantalin, vascular surgery specialist in Saint-Laurent-du-Var.

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