Is TEVAR an Effective Approach to Prevent Complications after Surgery for Aortic Dissection Type A? A Systematic...

Area of Science:

• Cardiovascular Surgery
• Endovascular Interventions
• Aortic Disease Management

Background:

• Residual false lumen after Aortic Dissection type A (AD) treatment is linked to complications like malperfusion, rupture, aneurysm formation, and dissection expansion.
• Thoracic Endovascular Aortic Repair (TEVAR) is explored as a strategy to mitigate these post-treatment complications.

Purpose of the Study:

• To systematically review and analyze the implementation of TEVAR following prior AD treatment.
• To investigate the indications, methods, clinical outcomes, and aortic remodeling associated with TEVAR in this patient cohort.

Main Methods:

• Systematic review of published data from MEDLINE, SCIENCE DIRECT, GOOGLE SCHOLAR, and OVID databases.
• Analysis of 1410 articles, with 9 studies meeting inclusion criteria, totaling 157 patients.
• Evaluation of aortic remodeling parameters including diameter, true/false lumen dimensions, and false lumen thrombosis/patency.

Main Results:

• The majority of patients (84.7%) received TEVAR in zone 3 without infra-diaphragmatic extension.
• Overall mortality was 12.7%, with a 2.8% stroke rate.
• False lumen thrombosis occurred in 65.9% of patients, and the reintervention rate was 18.7%.

Conclusions:

• TEVAR is a commonly chosen approach after AD surgery, though its precise indications remain unclear.
• The procedure demonstrates safety and promotes aortic remodeling with an acceptable reintervention rate.
• Development of definitive guidelines is recommended to establish the benefit of TEVAR as a preventive measure and define selection criteria.