The impact of thoracic endovascular aortic repair on long-term survival in type B aortic dissection
Type B aortic dissection (AD) is a potentially fatal disease with poor long-term outcome. In the modern endovascular era, thoracic endovascular aortic repair (TEVAR) is considered the treatment of choice in complicated acute type B AD, whereas uncomplicated acute type B AD has traditionally been managed non-operatively (1). Approximately 30% of type B AD patients present with ischemia or rupture and represent a subgroup with significant in-hospital mortality (1). Indications for endovascular intervention include persistent or recurrent pain, uncontrolled hypertension despite full medication, early aortic expansion, malperfusion, and signs of rupture (hemothorax, increasing periaortic and mediastinal hematoma) (1). Those with an uncomplicated acute type B AD are treated with optimal medical therapy and life-long periodical imaging surveillance. The latter is crucial to detect significant late aneurysmal dilatation, which then needs to be addressed by endovascular procedures or open surgery. Given the disappointing long-term results with optimal medical therapy and the emerging data regarding the efficacy of TEVAR in remodeling the dissected aorta, many investigators now suggest a more aggressive strategy of TEVAR at the initial hospitalization for the treatment of patients with acute uncomplicated type B AD. However, quality evidence is lacking.