Abstract
Background The use of thoracic endovascular aortic repair
(TEVAR) for the management of uncomplicated type B aortic dissection
(un-TBAD) remains controversial. There is a lack of consensus over
whether pre-emptive TEVAR should be carried out in patients with un-TBAD
at risk of progression to complicated TBAD. We present a review of
current evidence and seek to suggest criteria where endovascular
intervention in un-TBAD may prove beneficial relative to pharmacotherapy
alone. Methods and Materials PubMed and Cochrane databases were
searched using terms including: type B aortic dissection, risk factors,
medical therapy, TEVAR, false lumen expansion, and mortality. Papers
were selected based on title and abstract. Results Optimal
medical therapy remains the mainstay treatment for patients with
un-TBAD, however patients with un-TBAD present with varying degrees of
disease progression risk. Factors such as age, aortic morphology,
history of connective tissue disorders, false lumen thrombosis, and
aortic branch involvement may potentiate progression from un-TBAD to
complicated TBAD. Short- and long-term outcomes associated with TEVAR
for TBAD remain promising. Conclusion Pre-emptive TEVAR may be
beneficial in patients with un-TBAD presenting with the above factors,
however further prospective research into the optimal timing for TEVAR
in un-TBAD is required.