Current perspectives in acute type B aortic dissections: a literature review

Area of Science:

• Cardiovascular Surgery
• Vascular Endovascular Therapy
• Thoracic Aortic Disease

Background:

• Endovascular strategies have transformed acute type B aortic dissection (aTBAD) management.
• Thoracic Endovascular Aortic Repair (TEVAR) is the gold standard for complicated aTBAD, with growing use in uncomplicated cases.
• Treatment goals have shifted towards achieving long-term positive aortic remodeling beyond simply covering the entry tear.

Purpose of the Study:

• To review and summarize current knowledge on the outcomes of various endovascular strategies for acute type B aortic dissection.
• To compare the effectiveness of different approaches, including TEVAR, PETTICOAT, and STABILISE, in managing aTBAD.
• To address the disparity in expert opinions regarding the optimal treatment for aTBAD.

Main Methods:

• Review of current literature and data on endovascular treatment strategies for aTBAD.
• Analysis of outcomes for techniques like TEVAR, PETTICOAT, and STABILISE.
• Examination of evidence regarding aortic remodeling and long-term results.

Main Results:

• TEVAR offers reduced in-hospital mortality and good long-term outcomes for complicated aTBAD.
• Techniques like PETTICOAT and STABILISE demonstrate safety and potential for excellent aortic remodeling and dissection healing.
• STABILISE results, while promising, necessitate validation through larger, medium-to-long-term studies.

Conclusions:

• Endovascular repair has become a cornerstone in aTBAD treatment, with evolving techniques aiming for complete aortic healing.
• Advanced strategies like PETTICOAT and STABILISE show potential for superior aortic remodeling in select aTBAD patients.
• Further validation of newer techniques through international registry data is crucial for establishing optimal treatment guidelines.