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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.
Annals of Vascular Surgery
|December 20, 2024
Summary
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.
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.
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