Key result
Thoracic endovascular aortic repair (TEVAR) offered superior mid- and long-term outcomes, including survival and aortic remodelling, over medical therapy in uncomplicated type B aortic dissection.
Why the study?
Studies have suggested TEVAR provides a survival benefit over conservative medical therapy in uncomplicated type B aortic dissection, with outcomes linked to timing of intervention, but evidence on mid- and long-term outcomes needed to be collated.
Does TEVAR improve mid- and long-term outcomes compared to medical therapy in patients with acute and subacute uncomplicated type B aortic dissection?
Does TEVAR improve mid- and long-term outcomes compared to medical therapy in patients with acute and subacute uncomplicated type B aortic dissection?
TEVAR provides superior mid- and long-term outcomes compared to medical therapy for uncomplicated type B aortic dissection, particularly when performed in the subacute phase.
TEVAR may confer survival benefit in un-TBAD; leaves open optimal timing and patient selection pending RCTs.
Background: Uncomplicated type B aortic dissection (un-TBAD) has been managed conservatively with medical therapy in order to control the heart rate and blood pressure to limit disease progression, in addition to radiological follow-up. However, several trials and observational studies have investigated the use of thoracic endovascular aortic repair (TEVAR) in un-TBAD and suggested that TEVAR provides a survival benefit over medical therapy. Outcomes of TEVAR have also been linked with the timing of intervention. Aims: The scope of this review is to collate and summarise all the evidence in the literature on the mid- and long-term outcomes of TEVAR in un-TBAD, confirming its superiority. We also aimed to investigate the relationship between timing of TEVAR intervention and results. Methods: We carried out a comprehensive literature search on multiple electronic databases including PubMed, Scopus and EMBASE in order to collate and summarise all research evidence on the mid- and long-term outcomes of TEVAR in un-TBAD, as well as its relationship with intervention timing. Results: TEVAR has proven to be a safe and effective tool in un-TBAD, offering superior mid- and long-term outcomes including all-cause and aorta-related mortality, aortic-specific adverse events, aortic remodelling, and need for reintervention. Additionally, performing TEVAR during the subacute phase of dissection seems to yield optimal results. Conclusion: The evidence demonstrating a survival advantage in favour TEVAR over medical therapy in un-TBAD means that with further research, particular trials and observational studies, TEVAR could become the gold-standard treatment option for un-TBAD patients.
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Jubouri et al. (2022) conducted a review in Uncomplicated type B aortic dissection (un-TBAD). Thoracic endovascular aortic repair (TEVAR) vs. Medical therapy was evaluated on Mid- and long-term outcomes including all-cause and aorta-related mortality, aortic-specific adverse events, aortic remodelling, and need for reintervention. Thoracic endovascular aortic repair (TEVAR) offered superior mid- and long-term outcomes, including survival and aortic remodelling, over medical therapy in uncomplicated type B aortic dissection.
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