Advances in endovascular repair for type A aortic dissection

To review the current status and advancements of endovascular repair for Type A Aortic Dissection (TAAD), considering its high mortality and the limitations of existing treatments like open surgical repair and hybrid repair.

Literature review was conducted to gather information on anatomical feasibility studies of various stent grafts, endovascular repair procedures (including aortic valve and ascending aorta repair, aortic arch repair techniques), and the advantages and disadvantages of endovascular repair.

Anatomical feasibility of commercial stent grafts for TAAD is low (4% - 21%), but the combination of stent and valve conceptually has a higher applicability (80%). Modular Endo-Bentall stent grafts have an overall anatomical feasibility of 66.4% for reconstructing coronary arteries. Different techniques for aortic arch repair (hybrid, fenestration, branched stent graft, parallel stenting) have shown various success rates and complications. For aortic arch repair, the technical success rates were 94.2 to 96.4% for fenestration, 98 to 100% for branched stent grafts, and 84 to 99.3% for parallel stents. The 30-day mortality ranged from 0 to 5%, stroke incidence from 0 to 18%, type I endoleak from 0 to 16%, and retrograde dissection from 0 to 5.4%.

Endovascular repair of TAAD is highly challenging. There is a lack of standardized and commercially available devices. More extensive clinical studies are needed to validate its safety and efficacy and to drive the development of optimized endovascular solutions.