BackTable / VI / Podcast / Episode #142

Type B Aortic Dissections

with Dr. Frank Arko

Interventional Radiologist Sabeen Dhand talks with Vascular Surgeon Frank Arko about endovascular treatment of Type B Aortic Dissections (TBAD), including patient selection, appropriate sizing, and complications to avoid.

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Type B Aortic Dissections with Dr. Frank Arko on the BackTable VI Podcast)
Ep 142 Type B Aortic Dissections with Dr. Frank Arko
00:00 / 01:04

BackTable, LLC (Producer). (2021, July 16). Ep. 142 – Type B Aortic Dissections [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Frank Arko discusses Type B Aortic Dissections on the BackTable 142 Podcast

Dr. Frank Arko

Dr. Frank Arko is a practicing Vascular Surgeon and the Chief of Vascular and Endovascular Surgery at Sanger Heart & Vascular Institute in Charlotte, North Carolina.

Dr. Sabeen Dhand discusses Type B Aortic Dissections on the BackTable 142 Podcast

Dr. Sabeen Dhand

Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.

Show Notes

In this episode, vascular surgeon Dr. Frank Arko and our host Dr. Sabeen Dhand give an overview of type B aortic dissections, which includes different methods of classifying dissections, workup and imaging, thoracic endovascular aortic repair (TEVAR), potential complications, and timeline for follow up care.

Dr. Arko starts the episode by defining vocabulary terms related to aortic dissections. He describes the Stanford and DeBakey classification systems that are used to signify the location of the dissection and the method of treatment (medical management or surgical/endovascular repair). He also distinguishes between complicated/uncomplicated dissections, as well as acute/subacute/chronic dissections.

When Dr. Arko discusses TEVAR, he mentions three important complications to be aware of: retrograde type A dissection, stroke, and spinal cord ischemia. He emphasizes that in the debate between optimal medical therapy and early TEVAR, more research on how to minimize these complications is needed before recommending widespread use of early TEVAR. During his walk through of the procedure, Dr. Arko also gives his insight on adjunct techniques such as PETTICOAT.

Finally, the doctors discuss special considerations for patients with pleural effusion, chronic hypertension, type II thoracoabdominal aneurysms, and connective tissue disorders.

Resources

Transcript Preview

[Dr. Frank Arko]
If you're going to talk about dissections, I would talk about first Type A and Type B. I think that's one that you need to understand. I think that's makes it relatively simple. I went to Stanford so I'm going to use just the Stanford and not the DeBakey. I think the DeBakey is a little bit more difficult to understand and define. I really focus on the on the Type B and and maybe the residual Type B following the type A. It's just a difference in where the the tears occur.

So I train a lot of fellows and residents, and I get to be a little bit of a stickler in some of the nomenclature for the repairs. Often times, when someone's younger and talking to you about a dissection, they're like, "Well, I got a symptomatic dissection, or I got a symptomatic dissection with a lot of pain." The first thing I said, "If you're going to get into the world of dissections, the first thing you need to really talk about is the complicated versus the uncomplicated.

Now, you can get into a whole lot of definitions about whether those are even good terminology. And to be honest with you, I have some problems with the complicated versus the uncomplicated nomenclature. But I think that is most important. The uncomplicated really, they just have a dissection and they don't really have much in the way of anything else causing them a problem.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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