TY - JOUR
T1 - Uncomplicated Type B Aortic Dissection: A European Multicentre Cross-Sectional Evaluation
AU - Bashir, Mohamad
AU - Jubouri, Matti
AU - Surkhi, Abdelaziz O.
AU - Williams, Ian M.
AU - Davidovic, Lazar B.
AU - Koncar, Igor
AU - Baltrūnas, Tomas
AU - Kunt, Aysegul
AU - Tanyeli, Ömer
AU - Bayram, Muhammed
AU - Ugur, Murat
AU - Rossi, Giovanni
AU - Stelzmueller, Marie-Elisabeth
AU - Hoksbergen, Arjan W.J.
AU - Jongkind, Vincent
AU - Bertoglio, Luca
AU - Zacà, Sergio
AU - Mansour, Wassim
AU - Sirignano, Pasqualino
AU - D'Oria, Mario
AU - Tolva, Valerio Stefano
AU - Van Herzeele, Isabelle
AU - Klincheva, Milka
AU - Atanasov, Zvonka
AU - Bartoli, Stefano
AU - Bellosta, Raffaello
AU - Chisci, Emiliano
AU - Guagliano, Alberto
AU - Teraa, Martin
AU - Ivak, Peter
AU - Recicarova, Sandra
AU - Pellenc, Quentin
AU - Heijmen, Robin
AU - Pfister, Karin
AU - Piffaretti, Gabriele
AU - Hutchings, Hayley
AU - Holland, Gail
AU - Bailey, Damian M.
AU - Thielmann, Matthias
AU - Jakob, Heinz
N1 - Possibly compliant version on Swansea's Cronfa repository - see <https://cronfa.swan.ac.uk/Record/cronfa68643>.
PY - 2025/4/25
Y1 - 2025/4/25
N2 - BACKGROUND: A multicentre European randomized control trial - European Uncomplicated Type B Aortic Repair (EU-TBAR) is being developed to compare pre-emptive thoracic endovascular aortic repair (TEVAR) with custom-made devices versus conventional optimal medical therapy. The pretrial set-up is confluent on different pillars, including evaluation of 1) European activity, trends, and governance; 2) outcome reporting; and 3) cost evaluation. This article aimed to demonstrate the observational cross-sectional survey results from participating centers and highlight the risk assessment, activity, practices, and governance of uncomplicated type B aortic dissection (uTBAD).METHODS: This observational cross-sectional European survey used a questionnaire that examined the understanding, risk assessment, local governance oversight, and clinical activity of uTBAD. The data were collected and managed using Research Electronic Data Capture (REDCap).RESULTS: Out of 43 surveyed surgeons, 37 (86%) responded within a month from 14 European countries. Most reported low annual uTBAD encounters, with autumn being the most common season for cases. Pre-emptive TEVAR was recommended by 43.2% of participants, who favored subacute intervention timing. The Gore TAG was the most used TEVAR device, and custom devices were available for 73% of respondents. Risk factors for uTBAD were ranked, with 'Rapid Aortic Enlargement' deemed most critical. A majority of centers had protocols and multidisciplinary teams, with most having readily available radiology services. Only 45.9% had transfer services to specialized centers.CONCLUSIONS: uTBAD remains a misnomer of a dynamic, ongoing disease process requiring early diagnosis and intervention. Pre-emptive TEVAR in high-risk uTBAD is becoming more common, with encouraging results prompting an expansion of indication criteria to a broader uTBAD population managed conservatively. Nevertheless, further evidence is needed through large randomized controlled trials, mainly European collaboratives, to reach a definitive conclusion on the optimum surgical management of uTBAD.
AB - BACKGROUND: A multicentre European randomized control trial - European Uncomplicated Type B Aortic Repair (EU-TBAR) is being developed to compare pre-emptive thoracic endovascular aortic repair (TEVAR) with custom-made devices versus conventional optimal medical therapy. The pretrial set-up is confluent on different pillars, including evaluation of 1) European activity, trends, and governance; 2) outcome reporting; and 3) cost evaluation. This article aimed to demonstrate the observational cross-sectional survey results from participating centers and highlight the risk assessment, activity, practices, and governance of uncomplicated type B aortic dissection (uTBAD).METHODS: This observational cross-sectional European survey used a questionnaire that examined the understanding, risk assessment, local governance oversight, and clinical activity of uTBAD. The data were collected and managed using Research Electronic Data Capture (REDCap).RESULTS: Out of 43 surveyed surgeons, 37 (86%) responded within a month from 14 European countries. Most reported low annual uTBAD encounters, with autumn being the most common season for cases. Pre-emptive TEVAR was recommended by 43.2% of participants, who favored subacute intervention timing. The Gore TAG was the most used TEVAR device, and custom devices were available for 73% of respondents. Risk factors for uTBAD were ranked, with 'Rapid Aortic Enlargement' deemed most critical. A majority of centers had protocols and multidisciplinary teams, with most having readily available radiology services. Only 45.9% had transfer services to specialized centers.CONCLUSIONS: uTBAD remains a misnomer of a dynamic, ongoing disease process requiring early diagnosis and intervention. Pre-emptive TEVAR in high-risk uTBAD is becoming more common, with encouraging results prompting an expansion of indication criteria to a broader uTBAD population managed conservatively. Nevertheless, further evidence is needed through large randomized controlled trials, mainly European collaboratives, to reach a definitive conclusion on the optimum surgical management of uTBAD.
U2 - 10.1016/j.avsg.2024.09.067
DO - 10.1016/j.avsg.2024.09.067
M3 - Article
C2 - 39706519
SN - 0890-5096
VL - 114
SP - 340
EP - 349
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
ER -