Improved Remodeling With TEVAR and Distal Bare-Metal Stent in Acute Complicated Type B Dissection

Abstract

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The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection

“…TEVAR can expeditiously control a rupture or cover the primary entry tear to restore true lumen flow, resulting in reduced ischemic time and improvement of outcomes over medical management alone or combined with open surgery. [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Collectively, accrued data demonstrate improved outcomes with TEVAR for complicated TBAD compared with open surgery or medical therapy alone. Consequently, TEVAR has become the first-line treatment for complicated TBAD.…”

Aortic remodelling and late outcomes following thoracic endovascular repair with a bare-metal stent distal extension among patients with complicated type-B aortic dissection

“…Sultan et al reported improved true lumen diameters and true lumen ratios of the abdominal aorta at the 6-month follow-up, among patients with type B aortic dissection undergoing the PETTICOAT technique compared to those undergoing TEVAR alone [ 20 ]. Similarly a recent analysis by Nienaber and colleagues of the patients from the ASSIST study found significantly more false lumen thrombosis in the abdominal aorta among patients undergoing the PETTICOAT technique compared to propensity matched patients who underwent TEVAR alone [ 17 ]. These results are similar to those found by Hashizume et al and Huang et al in their cohorts of patients [ 16 , 21 ].…”

A reversed strategy for treating type B aortic dissection with open aortoiliac replacement prior to thoracic endovascular aortic repair

“… 20 Conversely, others have reported that bare-metal stenting may offer positive remodeling in the distal aorta. 21 , 22 , 23 , 24 , 25 Concerns have also been raised that the PETTICOAT technique may jeopardize future adjunctive endovascular procedures because of stent strut interference. Other investigators have countered that a more expanded true lumen facilitates adjunctive procedures by virtue of the increase in workspace.…”