Are Risks Reduced by Delaying Thoracic Endovascular Aneurysm Repair in Patients with Acute Type B Dissection: Who Can Wait?

Malgor, Rafael D.; Verhoeven, Eric L.G.; Katsargyris, Αthanasios

doi:10.1016/j.ejvs.2019.07.020

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Most decision-making on timing of TEVAR in uncomplicated TBAD is extrapolated from the VIRTUE registry, the INSTEAD trials, and the ADSORB trial. 36 The VIRTUE registry assessed TEVAR outcomes in uncomplicated patients by chronicity. Both the acute and subacute phase showed greater reduction in false lumen area compared with the chronic cohort, and no difference was seen between the acute and subacute groups.…”

Section: Timing Of Tevarmentioning

confidence: 99%

Updates on Indications for TEVAR in Type B Aortic Dissection

Malaisrie

Mehta

2020

Innovations�(Phila)

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Section: Timing Of Tevarmentioning

confidence: 99%

Updates on Indications for TEVAR in Type B Aortic Dissection

Malaisrie

Mehta

2020

Innovations�(Phila)

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Uncomplicated Type B Aortic Dissection: Complicated Choices

Choke

Verhoeven

2020

European Journal of Vascular and Endovascular Surgery

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In this issue, Munshi et al. 1 surveyed 75 surgeons from Australia/New Zealand (ANZ)/Europe on their recommendations for uncomplicated Type B aortic dissection (TBAD). The authors reported interesting insights from the survey.The January 2017 European Society for Vascular Society (ESVS) Clinical Practice Guidelines 2 recommended that "In acute patients with uncomplicated type B dissection at risk of further aortic complications with suitable anatomy for endografting, endovascular repair should be considered in the subacute phase, in dedicated centres (Class IIa, Level B)".Essentially this recommendation provided guidance for three questions:(1) Should I offer thoracic endovascular aneurysm repair (TEVAR)? Yes (2) Who should get it? High risk uncomplicated TBAD (3) When to do it? During the subacute stage (2 weekse12 weeks)Evidence for (Question 1) was provided by the INSTEAD-XL randomised controlled trial, 3 which reported that TEVAR for stable uncomplicated TBAD, in addition to best medical therapy (BMT), was associated with improved five year aorta specific survival and delayed disease progression.However, the early TEVAR related deaths and complications, including paraplegia and stroke rates, raised concerns which mitigated the better five year survival with TEVAR. Hence, the management algorithm has evolved to include risk assessment to select patients who are at higher risk of further aortic complications, to maximise the benefits of pre-emptive TEVAR, an approach endorsed by the ESVS recommendation (Question 2).The first interesting insight from the Munshi et al. 1 survey was the surprisingly high level of conservatism among the surveyed surgeons. Only half of the surgeons followed the ESVS guidelines of considering pre-emptive TEVAR for "selected cases of stable uncomplicated TBAD". Taken from another angle, about half of surgeons surveyed would not recommend TEVAR for uncomplicated TBAD, even for selected high risk cases. Both ANZ and European surgeons were equally conservative in this respect.

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Are Risks Reduced by Delaying Thoracic Endovascular Aneurysm Repair in Patients with Acute Type B Dissection: Who Can Wait?

Cited by 2 publications

References 14 publications

Updates on Indications for TEVAR in Type B Aortic Dissection

Updates on Indications for TEVAR in Type B Aortic Dissection

Uncomplicated Type B Aortic Dissection: Complicated Choices

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