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

Abstract

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,