Endovascular treatment of acute type A aortic dissection

At present, standard of care for the management of acute type A aortic dissection (ATAAD) is emergent open surgical repair, which has excellent outcomes and in-hospital mortality rates of under 20%. However, an estimated 9% to 16% of patients are at prohibitive surgical risk and are medically managed, with in-hospital mortality rates as high as 57%. Endovascular therapies have emerged as a potentially life-saving alternative for the treatment of ATAAD. The current literature on endovascular treatment of ATAAD has demonstrated a mortality benefit and an acceptable risk profile when compared to medical management. Endovascular treatment involving the ascending aorta presents unique hemodynamic and anatomic challenges. Device innovation over the past two decades has introduced ascending aortic and aortic arch devices, as well as the off-label use of descending stent-grafts and off-label modifications to stent-grafts and transcatheter valves in the Endo-Bentall technique. Given the variations in anatomy, it is predicted that less than half of patients would be eligible for endovascular repair. Further research and application of these stent devices are critical for making endovascular therapy more applicable to a high-risk population with ATAAD.