What is the optimal timing for Thoracic Endovascular Aortic Repair in
uncomplicated Type B aortic dissection? Facts, fallacies and the future
Abstract
Background: Uncomplicated Stanford Type B aortic dissection (un-TBAD) is
characterised by a tear in the aorta distal to the left subclavian
artery without ascending aorta and arch involvement. Optimised
cardiovascular control (blood pressure and heart rate) is the current
gold standard treatment according to current international guidelines.
However, emerging evidence indicates that Thoracic Endovascular Aortic
Repair (TEVAR) is both safe and effective in the treatment of un-TBAD
with improved long-term survival outcomes in combination with optimal
medical therapy (OMT) relative to OMT alone. However, the optimal
timeframe for intervention is not entirely clarified. Aims: This review
critically addresses current state-of-the-art comparing TEVAR with OMT
and corresponding clinical outcomes for un-TBAD based on timing of
intervention. Methods: We carried out a comprehensive literature search
on multiple electronic databases including PUBMED and Scopus in order to
collate all research evidence on timing of TEVAR in uncomplicated Type B
aortic dissection. Results: TEVAR has proven to be a safe and effective
treatment for un-TBAD in combination with OMT through comparable
survival outcomes, improved aortic remodelling, and relatively low
periprocedural added risks. Though the timing of intervention remains
controversial, it is becoming clear that performing TEVAR during the
subacute phase of un-TBAD yields better outcomes compared to earlier and
delayed (>90 days) intervention. Conclusions: Further
research is required into both short and long-term outcomes of TEVAR in
addition to its optimal therapeutic window for un-TBAD. With stronger
evidence, TEVAR is likely to be adopted as the gold-standard
intervention for un-TBAD with definitive timeframe guidelines.