Thoracic endovascular aortic repair for acute complicated type B aortic dissection: Superiority relative to conventional open surgical and medical therapy

Abstract

Thoracic endovascular aortic repair for acute complicated type B dissection is associated with superior early outcome and improved midterm survival relative to conventional therapy. Longer follow-up demonstrating survival benefit is needed before definitive conclusion can be made.

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…55,60,77,86,87 In these settings, TEVAR has shown a substantial advantage over OR in terms of early mortality.…”

“…99 Another study confirmed these findings with an in hospital mortality of 4%, 40%, and 33% in TEVAR, OR, and medically treated patients, respectively. 87 However, there is no evidence that extended coverage of the DTA is needed to restore distal perfusion.…”

“…87,92,109 Therefore, life long clinical and imaging surveillance are advised in this situation 6 (see also Section 4. ).…”

Evolution of diagnosis and clinical outcomes in acute aortic dissection: data from the International Registry of Acute Aortic Dissection

“…In a paper from the University of Pennsylvania Medical Center, the in-hospital mortality rate following endovascular repair for complicated type B AAD was only 4% than open surgical therapy (40%) and medical therapy (33%) (P=0.006). In addition, the benefit of endovascular repair has been conveyed as demonstrated by improved 5-year survival with evidence of aortic remodeling (10). Regarding type B AAD, endovascular repair is becoming popular in light of more evidence of improved early and late outcomes.…”

Emergency TEVAR for Complicated Acute Type B Aortic Dissection

“…Despite an improved surgical technique and perioperative care, the early mortality rate of conventional open repair for ruptured acute type B aortic dissection are 30 -40 % (Sachs T, et al, 2010, Zeeshan A, et al, 2010. Because clinical status of patients with rupture is already in a critical condition before surgery, a less-invasive initial treatment should be desirable, such as TEAVR.…”