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

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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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