A type B aortic dissection (Stanford classification) is identified in a 58-year-old hypertensive man. He is haemodynamically stable with no end-organ ischaemia or malperfusion. What is the INITIAL treatment of choice?
- A Medical management with intravenous beta-blockers (heart rate and blood pressure control) ✓
- B Emergency open surgical repair
- C Thoracic endovascular aortic repair (TEVAR)
- D Anticoagulation with heparin to prevent thrombosis of false lumen
Explanation
Uncomplicated Stanford Type B aortic dissection (involving the descending thoracic aorta without retrograde extension to the ascending aorta) is initially managed medically with IV beta-blockers (labetalol, esmolol) targeting heart rate <60 bpm and systolic BP <120 mmHg to reduce aortic wall stress. Surgery or TEVAR is reserved for complicated Type B dissection (malperfusion, rupture, uncontrolled pain, rapid expansion). The ADSORB and INSTEAD trials assessed TEVAR in uncomplicated Type B dissection and showed remodelling benefits without clear early survival advantage over medical therapy.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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