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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
THORACIC AORTA UPDATE
Journal of Vascular and Endovascular Surgery 2009 June;16(2):117-25
Fit patients with uncomplicated aortic dissection and a dilated aorta should have TEVAR
Nordon I. M., Hinchliffe R. J., Holt P. J., Morgan R., Loftus I. M., Thompson M. M.
St George’s Vascular Institute St James’ Wing, St George’s Hospital, London, UK
Endovascular treatment is increasingly being applied to aortic pathology. Chronic type B aortic dissection complicated by aneurysmal dilatation is pathology where endovascular graft deployment appears to offer a logical and low morbidity therapeutic solution. Reports confirm a high level of primary technical success and a low incidence of complications in fit patients following thoracic endovascular aortic repair (TEVAR). In chronic aortic dissection there is limited potential for inducing aortic remodeling. Stent-graft deployment can induce false lumen thrombosis, reducing the risk of disease progression and subsequent aneurysm rupture. Although there is currently no long-term evidence, this data will become available as the stent-graft registries mature. This review presents the current evidence for TEVAR in the management of chronic type B aortic dissection in “fit for surgery” patients. It discusses the natural history of the disease, goals and methodology of treatment and compares outcomes with established open surgical procedures.