Type B Aorta Dissection

April 11, 2008, my husband had a Type B Aorta Dissection.  There is a focal, saccular dissection of the distal thoracic aorta at the diaphragmatic hiatus, extending into the proximal abdominal aorta.  The dissection is exclusively anterior and measures 4.6 cm in greatest dimension (cephalad to caudad) and is approximately 2.0 cm in greatest AP diameter.  The A-P diameter of the aorta at 1 level is 3.7 cm.  The dissection terminates just cephalad to the celiac artery.  The spinal arteries arise off the true lumen.  There has been no change since the 05/08 CTA.  He is being treated with Bystolic 10mg and Lisenopril 20mg.  

I stay in constant fear for him.  Can anyone tell me what his potential prognosis might be.  We are currently seeing a well-known cardiologist.  Should we seek another opinion?  Does anyone have any input?

[kenkeith]

Three treatment options exist for an aortic dissection: 1) medical management, 2) interventional catheterization, and 3) cardiovascular surgery. Depending upon the location and severity of the dissection, your physician will decide which option is best for you.  Your doctor chooses medical management...

Another opinion may recommend surgery!  A small percent of cases (5 - 10%) are Type B dissections (dissections of the descending aorta). This condition can be treated with surgical repair, but it carries significant risk. Typically, your doctor will monitor the condition periodically and prescribe medications to control the dissection.

More information on treatment:
Medical Therapy: Blood pressure and cholesterol lowering drugs, and treatment to reverse arteriosclerosis.

Endovascular Intervention: This minimally invasive procedure requires small incisions in the groin. Small wire-like, catheter devices called endoluminal stent grafts are threaded to the location of the dissection. These devices have a woven synthetic graft tip, which is deployed at the site of dissection and left in place. This provides a channel for blood to flow freely, repairing arterial leakage, and preventing pressure from rupturing the aorta. This procedure is much less invasive than the traditional open surgery, usually with a hospital stay of about 2-3 days and a recuperation period of a couple of weeks.... This procedure can only be performed on specific patients based on clinical criteria, and no long-term data exists regarding its effectiveness compared to open surgery.
Open Surgical Repair: The traditional treatment technique involves opening the chest and surgical removing the dissected aorta. A synthetic graft is sewn in its place for blood to flow freely to the rest of the arterial system. This procedure often requires a hospital stay of a week or more, and recuperation can take 6-8 weeks.