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Updated: May 15, 2026
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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Update in the management of aortic dissection
Jip L Tolenaar1, Guido H W van Bogerijen, Kim A Eagle
1Thoracic Aortic Research Center, IRCCS Policlinico San Donato, Cardiovascular Center E. Malan, University of Milan, Via Morandi, 30, 20097, San Donato Milanese, MI, Italy.
Current Treatment Options in Cardiovascular Medicine
|January 12, 2013
Summary
Advances in acute aortic dissection (AAD) care improve outcomes. Type A AAD requires surgery, while Type B AAD is medically managed, with thoracic endovascular aortic repair (TEVAR) increasingly used for complicated cases.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Medical Technology
Background:
- Acute aortic dissections (AAD) management has evolved with improved diagnosis, peri-operative care, and surgical techniques, leading to reduced mortality and morbidity.
- The traditional algorithm differentiates Type A AAD (surgical intervention) from Type B AAD (medical management), though initial medical therapy is standard for all AAD.
- Recent advancements include cerebral protection strategies and aortic valve repair in Type A AAD, and the growing role of thoracic endovascular aortic repair (TEVAR).
Purpose of the Study:
- To review current management strategies for acute aortic dissections (AAD), focusing on surgical and endovascular interventions.
- To highlight the evolving role of thoracic endovascular aortic repair (TEVAR) in both Type A and Type B aortic dissections.
- To emphasize the importance of long-term medical management and surveillance for all AAD patients.
Main Methods:
- Review of current literature and treatment algorithms for acute aortic dissections.
- Discussion of surgical techniques for Type A AAD, including cerebral protection and valve repair.
- Analysis of the application of thoracic endovascular aortic repair (TEVAR) in complicated Type B AAD and potential future uses in Type A AAD.
Main Results:
- Improved surgical techniques and peri-operative care have decreased mortality and morbidity in AAD.
- TEVAR is the primary treatment for complicated Type B AAD, effectively managing malperfusion and promoting aortic remodeling.
- Hybrid procedures combining open repair and TEVAR are used for Type A AAD involving the descending aorta, with potential for future total endovascular repair.
Conclusions:
- Management of AAD has significantly improved, with specialized surgical techniques for Type A and TEVAR for complicated Type B dissections.
- TEVAR is a crucial tool for complicated Type B AAD and shows promise for Type A AAD, potentially enabling total endovascular repair in the future.
- All patients with AAD require lifelong antihypertensive management, imaging surveillance, and clinical follow-up, regardless of initial treatment modality.
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