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Online ISSN 1827-1847
THORACIC AORTA UPDATE
De Rango P. 1, Safi H. J. 2, Estrera A. L. 2
1 Division of Vascular and Endovascular SurgeryUniversity of Perugia, S. Maria della Misericordia Hospital Perugia, Italy
2 Department of Cardiothoracic and Vascular Surgery University of Texas Medical School, Memorial Hermann Heart and Vascular Institute, Houston, TX, USA
Endovascular stent-grafting has come to be considered a first-line treatment for complicated type-B dissection, due to the high technical success rate and improved mortality and morbidity, when compared to open surgical alternatives. However, it is controversial whether patients should be stent-grafted prophylactically in cases of uncomplicated subacute or chronic type B dissection, or in cases with aortic dilations. It is unclear whether stent-grafting can help in reducing false lumen pressurization or in promoting aortic remodeling and shrinkage in patients with chronic dissection, considering the presence of multiple fenestrations between true and false lumen (FL), as well as the thicker and stronger aortic flap and wall. There are several reports, mainly single-center or case series, of endovascular repair in asymptomatic chronic descending of aortic dissection as well as in the presence of dilation. These have confirmed technical feasibility, low rate of complications (paraplegia, mortality, stroke) and ability to provide successful FL thrombosis, and prevention of late complications (including rupture and further aneurysm growth) in most cases. However, incomplete FL thrombosis and continued enlarging of the aorta, especially distal to the stented segment, are also major concerns. For this reason, the role of stent-grafting is still debated. In this review, all the available data are from sporadic series, with small sample sizes and limited follow-up. The only randomized study, performed in Europe, the INSTEAD, is still ongoing. Further clinical trials and larger comparative series with longer follow-up are needed in the treatment of uncomplicated aortic dissection.