Mid‐ and long‐term outcomes of thoracic endovascular aortic repair in acute and subacute uncomplicated type B aortic dissection

Abstract

Background Uncomplicated type B aortic dissection (un‐TBAD) has been managed conservatively with medical therapy to control the heart rate and blood pressure to limit disease progression, in addition to radiological follow‐up. However, several trials and observational studies have investigated the use of thoracic endovascular aortic repair (TEVAR) in un‐TBAD and suggested that TEVAR provides a survival benefit over medical therapy. Outcomes of TEVAR have also been linked with the timing of intervention. Aims The scope of this review is to collate and summarize all the evidence in the literature on the mid‐ and long‐term outcomes of TEVAR in un‐TBAD, confirming its superiority. We also aimed to investigate the relationship between the timing of TEVAR intervention and results. Methods We carried out a comprehensive literature search on multiple electronic databases including PubMed, Scopus, and EMBASE to collate and summarize all research evidence on the mid‐ and long‐term outcomes of TEVAR in un‐TBAD, as well as its relationship with intervention timing. Results TEVAR has proven to be a safe and effective tool in un‐TBAD, offering superior mid‐ and long‐term outcomes including all‐cause and aorta‐related mortality, aortic‐specific adverse events, aortic remodeling, and need for reintervention. Additionally, performing TEVAR during the subacute phase of dissection seems to yield optimal results. Conclusion The evidence demonstrating a survival advantage in favor TEVAR over medical therapy in un‐TBAD means that with further research, particular trials and observational studies, TEVAR could become the gold‐standard treatment option for un‐TBAD patients.

Changing Management of Type B Aortic Dissections

“…18 For dissections confined to zones 2 through 5 (from the left common carotid to the celiac artery), simple TEVAR with or without left subclavian artery revascularization is usually effective at achieving both short-and long-term success as measured by complete false lumen remodeling and avoidance of additional procedures. 22,23 For acute TBAD involving zone 1, either endovascular revascularization or extra-anatomic surgical debranching of the left common carotid and left subclavian arteries can achieve equally durable long-term results. But in patients managed medically or in TEVAR patients with dissection involving the visceral aorta and the aortic bifurcation (zones 6-11), the long-term outcomes of acute and subacute TBAD are dominated by the inexorable enlargement of the untreated aortic segments.…”

Population risk profile analysis of acute uncomplicated type B aortic dissection patients undergoing thoracic endovascular aortic repair

“…The high short-term mortality following TEVAR compared to OMT is inextricably linked to procedure-associated complications which can be subclassified into all-cause or aorta-specific. 66 Nonetheless, some demographic characteristics and co-morbidities were shown to pose a post-procedural risk of complications or treatment failure. Analysis of individual risk profiles is imperative and can significantly contribute to determining the best candidates with unTBAD to undergo TEVAR and possibly reduce unnecessary treatment.…”

The misnomer of uncomplicated type B aortic dissection

“…There is evidence that remodeling is most effective in the subacute phase (15-30 days), and if a TBAD is considered for intervention, then it should be performed within the initial 90 days since symptom onset. 16,17 Jubouri et al 18 recently highlighted the evidence in the literature on the mid-and long-term clinical outcomes of TEVAR in UnCoTBAD, demonstrating its superiority to OMT. 19 The first group was OMT and TEVAR while the second group was OMT alone with the primary outcome measure being 2-year mortality rates.…”