Pre-Emptive Endovascular Repair for Uncomplicated Type B Dissection - Is This an Option?

Abstract

Type B aortic dissection (TBAD) primarily affects men aged 60-65 years, with hypertension in over 80% of cases. The gold standard for the treatment of uncomplicated acute TBAD is Best Medical Treatment (BMT), which focused on controlling blood pressure and heart rate. However, Thoracic Endovascular Aortic Repair (TEVAR) has gained attention over the years, especially for complicated TBAD cases, by covering the primary entry tear, lowering false lumen pressure, and promoting aortic remodeling. TBAD can be classified according to the onset of symptoms into acute, subacute and chronic stages, with different intervention implications at each stage. Studies such as the Acute Dissection Stentgraft OR Best Medical Treatment and Investigation of STEnt grafts in Acute Dissection trials have shown the benefits of TEVAR over BMT, particularly in promoting aortic remodeling and reducing long-term aorta-related mortality. However, these trials noted no significant difference in immediate mortality. TEVAR timing is crucial, as early intervention in the acute phase can lead to higher complication rates due to higher intimal fragility. As a result, the subacute phase offers a balance, allowing beneficial remodeling with a lower complication rate.