Role of thoracic endovascular aortic repair in the management of acute type B aortic dissection

Abstract

Thoracic endovascular aortic repair (TEVAR) is the optimal therapy for the treatment of complicated acute type B aortic dissection (aTBAD). Numerous studies have confirmed its efficacy in improving early survival and minimizing the risk of adverse events compared to alternative treatments.Moreover, growing evidence demonstrates its ability to remodel the aorta, improve aortic-specific survival, and decrease the need for aortic re-interventions at long-term follow-up. While uncomplicated aTBAD has traditionally been managed with optimal medical therapy (OMT), there is an increasing amount of data to suggest that OMT is a poor strategy for the treatment of TBAD in the chronic phase. Several recent studies have demonstrated that a significant number of patients with uncomplicated aTBAD treated with OMT require aortic intervention in the chronic phase due to aneurysmal degeneration of the false lumen (FL).Therefore, TEVAR has been increasingly proposed as an alternative therapy for patients with uncomplicated aTBAD, especially in patients with high-risk features. In this article, we summarize the most recent data regarding short-and long-term outcomes of TEVAR in complicated aTBAD that have established TEVAR as the standard of care for this presentation. Additionally, we address the unresolved issues in the management of uncomplicated aTBAD including the evolving use of TEVAR for this cohort of patients.