To review the imaging and treatment challenges of ruptured type B acute aortic dissections To present the lessons learned from a series of five patients treated for aortic ruptures in the setting of type B acute aortic dissections over a period of five years (2013-2018) at our institution

Aortic dissections are a complex disease that presents unique challenges. About one-third of patients with type B aortic dissections (TBAD) present with complications such as continuous aortic expansion, rupture, malpefrusion, uncontrollable pain or hypertension.[1] Ruptured type B aortic dissections (rTBAD) are a leading cause of death occurring at a rate of 3.6-20%.[2] Thoracic aortic endografting (TEVAR) is indicated as a first-choice therapy for complicated TBADs according to the recent ESVS guidelines (Level IC evidence). [3] Most large case series or reimbursment code reviews published, however,...

In the present work we review five cases of rTBADs treated in our institution with TEVAR. A TBAD patient usually presents with acute onset chest pain irradiated posteriorly with an ongoing hypertensive crisis. On the other hand, in cases of rupture, the patient can quickly become hypotensive as hemorrhagic shock ensues or there can be a variety of intermediate hemodynamic states if the rupture is contained. Usually pleural effusion is present which can become massive left/right hemothorax but also hemomediastinum with compression of the trachea...

Although the standard technique for TEVAR for the treatment of TBAD is effective the reality of extremely heterogeneous clinical and morphological presentation of aortic ruptures requires a great deal of creativity and readiness to resolve a variety of issues. Limited coverage of the entry tear with extension distal to the possible site of rupture has performed well in all but one case in our series. Younger patients with more elastic aortas are significantly more challenging and perhaps open surgery still has a role to play.

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