Navigating Contemporary Strategies in Endovascular Management of Descending Thoracic Aortic Dissection: A Comprehensive Review of the Literature

Introduction: Acute aortic dissection (AD) is the deadliest form of acute aortic syndromes (AAS). Mortality is significant; around 80% in the highest-risk individuals. The challenge in managing AD is pronounced, especially with the high-risk open surgical approach. Endovascular aortic stent grafts offer a less invasive alternative. We retrospectively reviewed literature from 2004 to 2023 on type B AD endovascular management and focused on the newest patient series since the last meta-analysis (after January 2011).Materials and Methods: Identified from PubMed Central were two consensus papers, two randomized controlled trials, two historical articles, five meta-analyses, 31 clinical trials, and 50 review papers in English. Nineteen patient series from January 2011 onward were included, excluding non-English publications, duplicate reports and papers dealing only with type A AD or only with true thoracic aortic aneurysms (TAA).Results: Among 4235 patients in 19 publications, 69.2% had type B AD. Thoracic endovascular aortic repair (TEVAR) was performed in 90.5% of patients, with a 5.9% 30-day mortality rate. Complications included type I-II (and sometimes III) endoleaks (11.1%), stroke (5.5%), and paraplegia or paraparesis (3.2%). The need for re-intervention was around 17.7%, and the mean follow-up time was 36.4 (±20.7) months.Conclusion: This review highlights TEVAR's technical success, potential advantages, complications, and survival rates for type B AD patients with its long-term efficacy still undetermined.