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Online ISSN 1827-1847
NEW DEVELOPMENTS IN TREATMENT OF THE AORTIC ARCH AND AORTIC DISSECTIONS
Nozdrzykowski M., Mohr F.-W., Garbade J.
Department of Cardiac Surgery, Heart Center Leipzig University of Leipzig, Leipzig, Germany
The optimal management of type B aortic dissection remains controversial and is still a matter of debate. Uncomplicated type B dissection is traditionally managed medically with aggressive anti-impulse and antihypertensive pharmacotherapy. However, during follow-up approximately half of the patients with chronic dissection will develop an expansion of the false lumen and subsequent aneurysm, which required changes in the treatment concept. Surgical resection and interposition of vascular prostheses have long been considered as a standard procedure for chronic type B aortic dissection. However, conventional open surgery is associated with significant mortality and morbidity. Thoracic endovascular aortic repair (TEVAR) has been established as an alternative to surgical treatment of type B aortic dissection for high-risk patients with unclear overall life expectancy or to achieve rapid aortic stabilization in the acutely unstable patient. However, procedural success — in combination with the potential advantage of less invasive repair — has led to a progressive use of this technique. The goals of endovascular stent graft deployment are closure of the proximal entry tear and subsequent depressurization of the false lumen, redirection of blood flow towards the true lumen, thrombosis of the false lumen and induction of aortic remodelling. Treating of the chronic type B aortic dissection with thoracic aortic repair has been frequently reported in the literature, there is no level 1 evidence presented benefit of this treatment in the long-term follow-up. On the other hand, with improved early outcomes of TEVAR compared with open surgery, the application of stent graft expanded to a wide spectrum of aortic pathologies. This more liberal use of TEVAR carries the risk of serious complications that may require conversion to open repair. The purpose of this review is to present current evidence for thoracic endovascular aortic repair of chronic type B aortic dissection.