Alternative management of proximal aortic dissection: concept and application

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Medicine

Background:

• Open surgery is the primary treatment for acute type A aortic dissection.
• Elderly patients often present with high surgical risks or futility, necessitating alternative treatments.
• Endovascular approaches for ascending aorta dissection are limited by anatomical and technical challenges.

Purpose of the Study:

• To evaluate the potential and limitations of endovascular treatment for acute type A aortic dissection, particularly in non-surgical candidates.
• To highlight the anatomical and technical challenges of endovascular repair in the ascending aorta.
• To discuss the current status and future directions for endovascular therapies in complex aortic dissections.

Main Methods:

• Review of existing literature on endovascular treatment for acute type A aortic dissection.
• Analysis of case reports and small series focusing on endovascular stent-graft application.
• Discussion of anatomical considerations and technical limitations in the ascending aorta.

Main Results:

• Endovascular treatment has been applied to a small subset of high-risk patients with limited data.
• Significant anatomical and technical challenges exist for endovascular repair of the ascending aorta.
• Thoracic endovascular aortic repair (TEVAR) is established for distal dissections but limited for type A.

Conclusions:

• Endovascular stent-graft treatment is a potential last resort for selected type A dissection patients unsuitable for surgery, with mixed results.
• Further technical improvements and specially designed endografts are necessary for satisfactory endovascular options.
• Careful patient selection based on favorable anatomy is crucial for current endovascular interventions in acute type A aortic dissection.