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Criteria for Endovascular Intervention in Type B Aortic Dissection
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  • Sven Zhen Cian Tan,
  • Sidhant Singh,
  • Joaquin Alfonso Palanca,
  • Natasha Austin J,
  • Matti Jubouri,
  • Damian Bailey,
  • Ian Williams,
  • Christoph Nienaber,
  • Joseph Coselli,
  • Mohamad Bashir
Sven Zhen Cian Tan
Queen Mary University of London Barts and The London School of Medicine and Dentistry
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Sidhant Singh
Queen Mary University of London Barts and The London School of Medicine and Dentistry
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Joaquin Alfonso Palanca
Queen Mary University of London Barts and The London School of Medicine and Dentistry
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Natasha Austin J
Queen Mary University of London Barts and The London School of Medicine and Dentistry
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Matti Jubouri
Hull York Medical School
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Damian Bailey
University of South Wales Faculty of Life Sciences and Education
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Ian Williams
University Hospital of Wales
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Christoph Nienaber
Royal Brompton and Harefield Hospitals
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Joseph Coselli
Baylor College of Medicine Michael E DeBakey Department of Surgery
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Mohamad Bashir
NHS Wales Health Education and Improvement Wales
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Abstract

Background The use of thoracic endovascular aortic repair (TEVAR) for the management of uncomplicated type B aortic dissection (un-TBAD) remains controversial. There is a lack of consensus over whether pre-emptive TEVAR should be carried out in patients with un-TBAD at risk of progression to complicated TBAD. We present a review of current evidence and seek to suggest criteria where endovascular intervention in un-TBAD may prove beneficial relative to pharmacotherapy alone. Methods and Materials PubMed and Cochrane databases were searched using terms including: type B aortic dissection, risk factors, medical therapy, TEVAR, false lumen expansion, and mortality. Papers were selected based on title and abstract. Results Optimal medical therapy remains the mainstay treatment for patients with un-TBAD, however patients with un-TBAD present with varying degrees of disease progression risk. Factors such as age, aortic morphology, history of connective tissue disorders, false lumen thrombosis, and aortic branch involvement may potentiate progression from un-TBAD to complicated TBAD. Short- and long-term outcomes associated with TEVAR for TBAD remain promising. Conclusion Pre-emptive TEVAR may be beneficial in patients with un-TBAD presenting with the above factors, however further prospective research into the optimal timing for TEVAR in un-TBAD is required.

Peer review status:ACCEPTED

01 Jan 2022Submitted to Journal of Cardiac Surgery
07 Jan 2022Assigned to Editor
07 Jan 2022Submission Checks Completed
07 Jan 2022Reviewer(s) Assigned
10 Jan 2022Review(s) Completed, Editorial Evaluation Pending
10 Jan 2022Editorial Decision: Accept