Role of Endoluminal Techniques in the Management of Chronic Type B Aortic Dissection
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REVIEW
Role of Endoluminal Techniques in the Management of Chronic Type B Aortic Dissection Konstantinos Spanos1
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Tilo Ko¨lbel1
Received: 29 November 2019 / Accepted: 20 June 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract In recent guidelines of international societies, the most frequent indication for treatment after chronic type B aortic dissection (cTBAD) is aneurysmal dilatation. Endovascular repair is recommended in patients with moderate to high surgical risk or with contraindications to open repair. During the last decade, many advances have been made in the field of endovascular techniques and devices. The aim of this article is to address the current status of endoluminal techniques for the management of cTBAD including standard thoracic endovascular repair, new devices, fenestrated and branched abdominal aortic devices and false lumen occlusion techniques. Keywords Chronic type B dissection Endovascular repair TEVAR Inner branch device Remodeling
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00270-020-02566-7) contains supplementary material, which is available to authorized users. & Konstantinos Spanos [email protected] 1
German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
Introduction Guidelines on the treatment of aortic dissection have traditionally supported that uncomplicated type B aortic dissection (TBAD) is treated by best medical treatment (BMT) [1, 2]. However, about 25 to 50% of patients who survive the acute phase will require open repair or thoracic endovascular aortic repair (TEVAR) during the chronic phase [3, 4]. The INSTEAD XL study showed improved survival and delayed disease progression of survivors of TBAD who underwent TEVAR in addition to BMT during the subacute phase (14–90 days) [5]. A recent systematic review [6] highlighted that secondary interventions after BMT ranged between 9.0% and 40.6% in patients with TBAD. The lack of follow-up data for conservatively treated patients, presence of heterogeneity in patients and absence of consensus reporting standards for TEVAR are obstructing the interpretation of outcomes [7]. No randomized controlled trial exists comparing open surgical repair (OSR) and TEVAR for cTBAD treatment. In a systematic review by Kamman et al. [6], mortality of TEVAR for cTBAD was favorable compared to OSR. Another recent study demonstrated that TEVAR for cTBAD even in complicated cases was safe and effective. While aortic remodeling was favorable proximal to the coeliac artery after TEVAR, the low rate of distal false lumen thrombosis warranted further imaging surveillance [8]. TEVAR for aortic dissection started 20 years ago [9] and is still developing with novel techniques and devices. The aim of this article is to address the current status of endoluminal techni
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