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What is the best thoracic endovascular aortic repair landing zone for Type B aortic dissection?
Gregory A Magee1, Firas F Mussa2
1Division of Vascular and Endovascular Surgery, NYU Langone Health, 550 First Avenue, 11th Floor, New York, NY 10016.
Insights
Choosing the right landing zone for thoracic endovascular aortic repair is crucial. Zone 2 offers proximal landing but increases stroke risk, while distal zone 5 is linked to spinal cord ischemia and should be avoided.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Disease
Background:
- Thoracic endovascular aortic repair (TEVAR) requires careful consideration of landing zones.
- Proximal landing in healthy aorta is recommended, often necessitating zone 2 for left subclavian artery entry tears.
- Zone 2 TEVAR is associated with increased risks of stroke and left subclavian artery revascularization.
Abstract:
Dissection morphology is important when considering landing zones for thoracic endovascular aortic repair. Landing proximally in a healthy aorta, free of dissection and intramural hematoma, is generally recommended. For the most common location of the proximal entry tear near the left subclavian artery, this generally requires landing in zone 2. However, zone 2 landing is associated with higher rates of stroke and need for left subclavian revascularization. Distal landing zone 5 is associated with much higher rates of spinal cord ischemia, without significant benefit over zone 4 or bare metal stent extension so should be avoided, especially for treatment of uncomplicated dissections.
