Mid- and long-term outcomes of thoracic endovascular aortic repair in
acute and subacute uncomplicated type B aortic dissection
Abstract
Background: Uncomplicated type B aortic dissection (un-TBAD) has been
managed conservatively with medical therapy in order to control the
heart rate and blood pressure to limit disease progression, in addition
to radiological follow-up. However, several trials and observational
studies have investigated the use of thoracic endovascular aortic repair
(TEVAR) in un-TBAD and suggested that TEVAR provides a survival benefit
over medical therapy. Outcomes of TEVAR have also been linked with the
timing of intervention. Aims: The scope of this review is to collate and
summarise all the evidence in the literature on the mid- and long-term
outcomes of TEVAR in un-TBAD, confirming its superiority. We also aimed
to investigate the relationship between timing of TEVAR intervention and
results. Methods: We carried out a comprehensive literature search on
multiple electronic databases including PubMed, Scopus and EMBASE in
order to collate and summarise all research evidence on the mid- and
long-term outcomes of TEVAR in un-TBAD, as well as its relationship with
intervention timing. Results: TEVAR has proven to be a safe and
effective tool in un-TBAD, offering superior mid- and long-term outcomes
including all-cause and aorta-related mortality, aortic-specific adverse
events, aortic remodelling, and need for reintervention. Additionally,
performing TEVAR during the subacute phase of dissection seems to yield
optimal results. Conclusion: The evidence demonstrating a survival
advantage in favour TEVAR over medical therapy in un-TBAD means that
with further research, particular trials and observational studies,
TEVAR could become the gold-standard treatment option for un-TBAD
patients.