2．Stanford B型急性大動脈解離

Emergency Surgical Management for Stanford Type B Acute Aortic Dissection

日常診療で出会うStanford B型急性大動脈解離は，その多くが内科治療を選択され，施設によっては循環器内科が管理する場合も少なくない．しかしながら，破裂やmalperfusionといった合併症を有する症例（complicated type B）が一定数存在するのも事実であり，それらの病態を理解し，侵襲的治療のタイミングや方法を見誤らないことが重要である．

Since a certain number of patients with Stanford type B acute aortic dissection have complications such as rupture and malperfusion （complicated type B）, it is important to understand the pathogenesis of this condition and to avoid misjudging the timing and methods of invasive treatment such as thoracic endovascular aortic repair （TEVAR） and graft replacement. TEVAR is widely accepted as a less invasive treatment than conventional surgery, and is usually recognized as the first-line treatment, especially for complicated type B. On the other hand, there is still little clear evidence for TEVAR for uncomplicated type B without rupture or malperfusion, and careful selection of cases is considered necessary. In this review article, we describe the acute treatment of Stanford type B acute aortic dissection with reference to recent guidelines and literature.