Introduction
Aortic dissection (AD) in pregnancy is a rare and life-threatening complication. Data from the International Registry of Acute Aortic Dissection showed that aortic dissection in pregnancy accounts for 0.0004% of all pregnancies, and 0.1% to 0.4% of all aortic dissection1. Although, it was reported that pregnancy with type B aortic dissection (TBAD) accounts for 11% to 21% of this disease2. The incidence of TBAD during pregnancy and puerperium rose from 2002 to 2017 based on the data from the National Inpatient Sample (NIS) database of the United States3. Moreover, it was surprising that the hospital mortality of TBAD group was higher than that of type A AD (TAAD) group. In addition, it was reported that fetal outcomes were worse in TBAD group due to possible involvement of the iliac arteries4. Despite the elevated incidence and serious hazard of pregnant with TBAD, the optimal management strategy for this disease remains controversial and undetermined.
For TBAD in pregnancy, current treatment experience is still insufficient and primarily based on case reports and small case series. TBAD can be divided into complicated and uncomplicated according to clinical features and disease severity. Uncomplicated TBAD in is usually recommended to be treated medically, while complicated TBAD is preferably treated with thoracic endovascular aortic repair (TEVAR). The success rate of TEVAR for TBAD in unpregnant people was reported as high as 97.66% to 99.20%5. However, its effectiveness and safety in TBAD in pregnancy remains uncertain especially taken fetus life into consideration in late gestation. Therefore, it is necessary to explore the optimal treatment strategy for patients with TBAD in late pregnancy. This article summarized the data of five cases with complicated TBAD in late pregnancy at our center and analyzed the corresponding maternal and fetal outcomes. The aim of this study is to investigate an optimal management strategy of pregnant with complicated type B aortic dissection during the late second or third trimesters.