Thoracic endovascular aortic repair to treat uncomplicated Stanford type B aortic dissection: The surgeon's dilemma to preventing future complications.

Details

Serval ID
serval:BIB_F7E736568F89
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
Thoracic endovascular aortic repair to treat uncomplicated Stanford type B aortic dissection: The surgeon's dilemma to preventing future complications.
Journal
European journal of preventive cardiology
Author(s)
Tozzi P.
ISSN
2047-4881 (Electronic)
ISSN-L
2047-4873
Publication state
Published
Issued date
06/2018
Peer-reviewed
Oui
Volume
25
Number
1_suppl
Pages
24-31
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Review
Publication Status: ppublish
Abstract
Uncomplicated type B aortic dissections have traditionally been managed non-operatively with aggressive blood pressure control. However, the best medical treatment is associated with a considerable risk of disease progression to complicated dissection or aneurysmal degeneration of the affected aortic segment. Thoracic endovascular aortic repair could prevent long-term complications but, because the dissected aorta is vulnerable, it is a high-risk procedure performed in asymptomatic patient. Therefore, endovascular treatment is not a solution for all patients and it should be performed only in the subgroup prone to developing progression of the disease and future complications. A number of studies have suggested several prognostic factors of early or late adverse events such as the patency of the false lumen in the follow-up, an initial aortic diameter ≥4 cm with a patent false lumen, an initial false lumen diameter ≥22 mm in the proximal descending aorta, visceral involvement and recurrent or refractory pain or hypertension. Partial false lumen thrombosis and a proximal entry tear size >10 mm have also been suggested to be associated with an increased rate of aortic growth. We need randomised trials focused on these prognostic factors to reach level 1, class A recommendation for the optimal timing of intervention. Meanwhile, we have to discuss with the patient the pro and cons of this prophylactic, low-invasive but high-risk treatment to personalise medical care and provide the optimal risk-to-benefit ratio.
Keywords
Aneurysm, Dissecting/diagnosis, Aneurysm, Dissecting/surgery, Aorta, Thoracic/diagnostic imaging, Aorta, Thoracic/surgery, Aortic Aneurysm, Thoracic/diagnosis, Aortic Aneurysm, Thoracic/surgery, Aortography, Decision Making, Endovascular Procedures/methods, Humans, Postoperative Complications/prevention & control, Thoracic Surgical Procedures/methods, Tomography, X-Ray Computed, Aortic dissection, aortic aneurysm, thoracic endovascular aortic repair
Pubmed
Web of science
Create date
03/05/2018 18:23
Last modification date
01/07/2019 6:10
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