REVIEW  THORACIC AORTIC CHALLENGES 

Italian Journal of Vascular and Endovascular Surgery 2020 March;27(1):26-37

DOI: 10.23736/S1824-4777.20.01450-3

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

TEVAR for high risk patients with uncomplicated type B aortic dissection: a paradigm shift

Aamir SHAH ^{1, 2}, Navyash GUPTA ¹, Bruce L. GEWERTZ ¹, Ali AZIZZADEH ¹ ✉

¹ Division of Vascular Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; ² Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

Patients with uncomplicated type B aortic dissection (TBAD) have historically been treated with medical therapy alone. Follow-up data, however, demonstrates that many of these patients subsequently develop aortic aneurysms and require intervention. The currently available scientific literature was reviewed to determine the optimal management strategy of patients with uncomplicated TBAD. Unfavorable long-term outcomes of patient with uncomplicated TBAD are primarily related to aneurysmal degeneration of the dissected aorta. Multiple studies that examine the role of TEVAR in selected high-risk patients are discussed. Predictors of aortic growth are reviewed and include aortic diameter greater than 40 mm, false lumen diameter greater than 22 mm, and the presence of a single or large entry tear in the proximal segment of the dissection. Optimal timing of (thoracic endovascular aortic repair) TEVAR is an important consideration: while intervention within the acute phase may be associated with an increased risk of complications such as retrograde type A dissection, the degree of aortic remodeling in the chronic phase may be limited. The current evidence supports a paradigm shift in the treatment of patients with uncomplicated TBD. Selected patients with high risk criteria are candidates for TEVAR with relatively low morbidity and mortality and demonstrated long-term benefit. Additional studies are needed to further define the optimal indications and timing of treatment in this cohort.

KEY WORDS: Endovascular procedures; Dissection; Aorta