Criteria for endovascular intervention in type B aortic dissection

Sidhant Singh, Joaquin A. Palanca, Natasha J. Austin, Sven Zhen Cian Patrick Tan, Matti Jubouri, Damian Bailey, Ian M. Williams, Christoph A. Nienaber, Joseph S. Coselli, Mohamad Bashir

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background
    The use of thoracic endovascular aortic repair (TEVAR) for the management of uncomplicated type B aortic dissection (un-TBAD) remains controversial. There is a lack of consensus over whether pre-emptive TEVAR should be carried out in patients with un-TBAD at risk of progression to complicated TBAD. We present a review of current evidence and seek to suggest criteria where endovascular intervention in un-TBAD may prove beneficial relative to pharmacotherapy alone.

    Methods and materials
    PubMed and Cochrane databases were searched using terms including: type B aortic dissection, risk factors, medical therapy, TEVAR, false lumen (FL) expansion, and mortality. Papers were selected based on title and abstract.

    Results
    Optimal medical therapy remains the mainstay treatment for patients with un-TBAD, however, patients with un-TBAD present with varying degrees of disease progression risk. Factors such as age, aortic morphology, history of connective tissue disorders, FL thrombosis, and aortic branch involvement may potentiate progression from un-TBAD to complicated TBAD. Short- and long-term outcomes associated with TEVAR for TBAD remain promising.

    Conclusion
    Pre-emptive TEVAR may be beneficial in patients with un-TBAD presenting with the above factors, however, further prospective research into the optimal timing for TEVAR in un-TBAD is required.
    Original languageEnglish
    Pages (from-to)987-992
    Number of pages6
    JournalJournal of Cardiac Surgery
    Volume37
    Issue number4
    Early online date27 Jan 2022
    DOIs
    Publication statusE-pub ahead of print - 27 Jan 2022

    Keywords

    • aorta
    • dissection
    • endovascular
    • TEVAR

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