Aortic dissection and its endovascular management

Aortic dissection is the commonest life-threatening event involving the aorta, affecting 5-10 per million people per year. Without treatment, half of patients with acute proximal aortic dissections die within 24 hours, and 60% of patients with acute distal aortic dissections die within 1 month. Only 10% of patients with proximal dissections and 40% of those with distal dissections will be alive at 1 year. Patients with chronic distal dissections are at risk of aortic rupture with nearly 20% requiring intervention. The aim of management of aortic dissection is to reduce propagation of the dissection plane and prevent the fatal complications of this condition. A paradigm shift in the surgical management of these patients began in the late 1990s with the reporting of two small series of patients being treated with custom-designed covered stents delivered through a unilateral arteriotomy. Both studies demonstrated the feasibility and technical success in endovascular sealing of the proximal intimal entry tear in patients with type B thoracic dissections.