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Uncomplicated Type B Aortic Dissection: A European Multicentre Cross-Sectional Evaluation.

Mohamad Bashir1, Matti Jubouri2, Abdelaziz O Surkhi3

  • 1Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.

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Uncomplicated type B aortic dissection (uTBAD) management varies across Europe. Pre-emptive thoracic endovascular aortic repair (TEVAR) is increasingly recommended for high-risk cases, but more trial evidence is needed.

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Area of Science:

  • Vascular Surgery
  • Aortic Diseases
  • Interventional Cardiology

Background:

  • The European Uncomplicated Type B Aortic Repair (EU-TBAR) trial is developing to compare pre-emptive thoracic endovascular aortic repair (TEVAR) with custom devices versus optimal medical therapy.
  • Pretrial setup involves evaluating European activity, trends, governance, outcome reporting, and cost-effectiveness for uncomplicated type B aortic dissection (uTBAD).
  • This study presents observational survey results on risk assessment, activity, practices, and governance of uTBAD across European centers.

Purpose of the Study:

  • To assess the current landscape of uncomplicated type B aortic dissection (uTBAD) management in Europe.
  • To highlight risk assessment strategies, clinical practices, and governance structures for uTBAD.
  • To inform the setup and objectives of the EU-TBAR randomized controlled trial.

Main Methods:

  • An observational, cross-sectional European survey using a questionnaire.
  • Data collected on understanding, risk assessment, local governance, and clinical activity related to uTBAD.
  • Data management and collection utilized Research Electronic Data Capture (REDCap).

Main Results:

  • 37 out of 43 surgeons (86%) from 14 European countries responded.
  • Most centers reported low annual uTBAD encounters; autumn was the most common season.
  • 43.2% of participants recommended pre-emptive TEVAR, favoring subacute timing. Rapid aortic enlargement was the most critical risk factor identified. The Gore TAG was the most used device, and custom devices were available in 73% of centers. Most centers had protocols and multidisciplinary teams, but only 45.9% had transfer services to specialized centers.

Conclusions:

  • Uncomplicated type B aortic dissection (uTBAD) is a dynamic disease requiring early diagnosis and intervention.
  • Pre-emptive TEVAR for high-risk uTBAD is gaining traction, potentially expanding indications.
  • Further large European collaborative randomized controlled trials are essential to determine optimal surgical management for uTBAD.