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

Jubouri, Matti; Al-Tawil, Mohammed; Yip, Ho Cheung Anthony; Bashir, Ali Kashif; Tan, Sven Z C P; Bashir, Mohamad; Anderson, Richard; Bailey, Damian; Nienaber, Christoph A.; Coselli, Joseph S.; Williams, Ian D.

doi:10.1111/jocs.16349

Cited by 11 publications

(3 citation statements)

References 65 publications

(228 reference statements)

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“…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.…”

Section: Long-term Outcomes Of Acute Tbadmentioning

confidence: 99%

Changing Management of Type B Aortic Dissections

Eidt,

Vasquez

2023

Methodist DeBakey Cardiovascular Journal

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The purpose of this manuscript is to review recent trends in the management of acute type B aortic dissection. Due to its efficacy and low morbidity, thoracic endografting has rapidly been adopted as the treatment of choice for most patients with malperfusion or rupture as a consequence of acute aortic dissection. This technology is increasingly applied to patients without rupture or malperfusion, so-called "uncomplicated" dissections, to reduce the incidence of late aneurysmal degeneration in the ungrafted segments of the thoracoabdominal aorta. A variety of techniques have been proposed, including intentional rupture of the dissection membrane to obliterate the false lumen as well as the candy-plug technique to eliminate retrograde flow in the false lumen.

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Section: Long-term Outcomes Of Acute Tbadmentioning

confidence: 99%

Changing Management of Type B Aortic Dissections

Eidt,

Vasquez

2023

Methodist DeBakey Cardiovascular Journal

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“…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.…”

Section: The Dilemma Of Tevar or Omt In Uncotbadmentioning

confidence: 99%

The misnomer of uncomplicated type B aortic dissection

Bashir

Jubouri

Tan

et al. 2022

Journal of Cardiac Surgery

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Background: Acute type B aortic dissection (TBAD) is a rare condition that can be divided into complicated (CoTBAD) and uncomplicated (UnCoTBAD) based on certain presenting clinical and radiological features, with UnCoTBAD constituting the majority of TBAD cases. The classification of TBAD directly affects the treatment pathway taken, however, there remains confusion as to exactly what differentiates complicated from uncomplicated TBAD.Aims: The scope of this review is to delineate the literature defining the intervention parameters for UnCoTBAD.Methods: A comprehensive literature search was conducted using multiple electronic databases including PubMed, Scopus, and EMBASE to collate and summarize all research evidence on intervention parameters and protocols for UnCoTBAD.Results: A TBAD without evidence of malperfusion or rupture might be classified as uncomplicated but there remains a subgroup who might exhibit high-risk features.Two clinical features representative of "high risk" are refractory pain and persistent hypertension. First-line treatment for CoTBAD is TEVAR, and whilst this has also

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“…In other words, these patients are ‘allowed' to progress from UnTBAD to CoTBAD under the banner of “medical management.” It is imperative to take the bull by its horn. Recently, the long‐term clinical benefits of thoracic endovascular aortic repair in UnTBAD have been enumerated 11 . Though larger randomized trials are warranted, with the limited evidence available, these patients have to be categorized based on laboratory, radiological and clinical parameter.…”

mentioning

confidence: 99%

Take the bull by its horn: “Prophylactic aortic intervention” in uncomplicated type B aortic dissection

Idhrees

2022

Journal of Cardiac Surgery

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Uncomplicated Stanford type B aortic dissection (UnTBAD) constitutes more than two-thirds of the type B aortic dissection. The present recommended management of UnTBAD is optimum medical management. On the other hand, intervention is warranted in patients with complicated Stanford type B aortic dissection (CoT-BAD). It is documented that nearly one-fourth of the patients who were initially diagnosed with UnTBAD may progress to CoTBAD. 1,2Furthermore, there is evidence that the aorta in 40% of UnTBAD develop dilatation within a period of 18 months. 3,4 To avoid these complications and progression of the natural disease, it has been suggested to identify the "high risk" subset of patients. Alexander et al. 5 in their review have enumerated a battery of risk factors to identify these "high risk" patients. They strongly recommended "timely prophylactic TEVAR intervention" in these patients. This brings us to a juncture where many questions are left unanswered with limited literature. "How to categorize high and lowrisk patients?" "What are the flow dynamics and pathophysiology of the Type B aortic dissection?" "What patient factors contribute to the progression of the disease?" "Is there a possible way to stop the progression of the disease?" 'allowed' to progress from UnTBAD to CoTBAD under the banner of "medical management." It is imperative to take the bull by its horn.Recently, the long-term clinical benefits of thoracic endovascular aortic repair in UnTBAD have been enumerated. 11 Though larger randomized trials are warranted, with the limited evidence available, these patients have to be categorized based on laboratory,

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

Cited by 11 publications

References 65 publications

Changing Management of Type B Aortic Dissections

Changing Management of Type B Aortic Dissections

The misnomer of uncomplicated type B aortic dissection

Take the bull by its horn: “Prophylactic aortic intervention” in uncomplicated type B aortic dissection

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