Is TEVAR really needed for uncomplicated type B aortic dissection?

Thoracic endovascular aortic repair (TEVAR) has quickly become the mainstay of treatment for acute aortic dissection, in particular cases of acute complicated Stanford Type B dissection (co‐TBAD). Necessarily, TEVAR carries with it the risk of postoperative complications, including stroke and renal failure. As a result, the management of patients with uncomplicated type B aortic dissection (un‐TBAD), which is generally accepted as being less severe, is safely managed via optimal medical therapy (OMT) alone. However, despite OMT, patients with un‐TBAD are at substantial risk of severe disease progression requiring delayed intervention. The cost–benefit ratio associated with TEVAR for un‐TBAD is therefore of key interest. Howard and colleagues produced a fascinating systematic review and meta‐analysis investigating the clinical outcomes of TEVAR for complicated and uncomplicated TBAD. Their data suggest that there is no significant difference in in‐hospital mortality or 5‐year survival between TEVAR for un‐TBAD and co‐TBAD, although the 30‐day mortality rate appeared to be higher in the co‐TBAD cohort. Patients with co‐TBAD appeared to also be at a higher risk of postoperative stroke and TEVAR endoleak, while un‐TBAD patients were at a higher risk of postoperative renal failure. Further prospective research into these relationships is recommended to fully elucidate the comparative efficacies of TEVAR for un‐TBAD and co‐TBAD.