Risk Profile Analysis of Uncomplicated Type B Aortic Dissection Patients
Undergoing Thoracic Endovascular Aortic Repair: Laboratory &
Radiographic Predictors
Abstract
Background: There is emerging evidence to support pre-emptive
thoracic endovascular aortic repair (TEVAR) intervention for
uncomplicated type B aortic dissection (unTBAD). Pre-emptive
intervention would be particularly beneficial in patients that have a
higher baseline risk of progressing to complicated TBAD (coTBAD). There
remains debate on the optimal clinical, laboratory, morphological and
radiological parameters which would identify the highest-risk patients
that would benefit most from pre-emptive TEVAR. Aim: This
review summarises evidence on the clinical, laboratory, and
morphological parameters that increase the risk profiles of unTBAD
patients. Methods: A comprehensive literature search was
carried out on multiple electronic databases including PubMed, EMBASE,
Ovid and Scopus in order to collate all research evidence on the the
clinical, laboratory, and morphological parameters that increase the
risk profiles of unTBAD patients Results: At present, there are
no clear clinical guidelines using risk-stratification to inform the
selection of unTBAD patients for TEVAR. However, there are noticeable
literature trends that can assist with the identification of the most
at-risk unTBAD patients. Patients are at particular risk when they have
refractory pain and/or hypertension, elevated C-reactive protein (CRP),
larger aortic diameter and larger entry tears. These risks should be
considered alongside factors that increase the procedural risk of TEVAR
to create a well-balanced approach. Advances in biomarkers and imaging
are likely to identify more pertinent parameters in future to optimise
the development of balanced, risk-stratified treatment protocols.
Conclusion: There are a variety of risk profiling parameters
that can be used to identify the high-risk unTBAD patient, with novel
biomarkers and imaging parameter emerging. Longer-term evidence
verifying these parameters would be ideal. Further randomized controlled
trials and multicentre registry analyses are also warranted to guide
risk-stratified selection protocols.