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Endovascular Repair vs Medical Therapy for Uncomplicated Acute Type B Dissection: Aortic Remodeling
Adrian Acuna Higaki1, Irbaz Hameed1, Ely Erez1
1Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Annals of Thoracic Surgery Short Reports
|October 30, 2025
Summary
Thoracic endovascular aortic repair (TEVAR) improves aortic remodeling and outcomes for uncomplicated acute type B aortic dissection (uATBAD) compared to medical therapy. TEVAR shows better short-term results and more pronounced positive remodeling in the thoracic aorta.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Disease
Background:
- Optimal initial management for uncomplicated acute type B aortic dissection (uATBAD) is not well-defined.
- This study compares thoracic endovascular aortic repair (TEVAR) with optimal medical therapy for uATBAD.
Purpose of the Study:
- To evaluate 1-year aortic remodeling and clinical outcomes.
- To compare TEVAR versus optimal medical therapy in patients with uATBAD.
Main Methods:
- Retrospective analysis of uATBAD patients treated with TEVAR (n=52) or optimal medical therapy (n=142).
- Comparison of clinical outcomes and aortic remodeling at presentation and 1-year follow-up.
- Assessment of true lumen diameter, full lumen diameter, true lumen index, and false lumen thrombosis at 12 thoracoabdominal levels.
Main Results:
- TEVAR demonstrated lower 30-day/in-hospital mortality (0% vs. 11.3%, P < .01).
- Greater improvement in true lumen diameter and index observed with TEVAR from the left subclavian artery to the diaphragm (P < .001).
- TEVAR led to significant false lumen thrombosis at thoracic aortic levels (P < .001).
Conclusions:
- TEVAR is associated with favorable aortic remodeling and improved short-term and midterm outcomes in uATBAD patients.
- Positive aortic remodeling is more significant at thoracic levels following TEVAR.
- TEVAR offers a viable alternative to medical management for uATBAD.
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