Thoracic endovascular stent-graft therapy in aortic dissection

PURPOSE OF REVIEWAortic dissection is an uncommon but highly lethal condition with a mortality rate of 1–2% per hour within the first 24 h when the ascending aorta is affected and remains a surgical domain. For the treatment of type B aortic dissection, however, endovascular techniques became available recently and are increasingly popular. This review focuses on current indications and results of thoracic endovascular stent-graft therapy in aortic dissection. RECENT FINDINGSUncomplicated type B aortic dissections should be managed medically and kept under surveillance for delayed expansion in 20–50% patients over 4 years. Endovascular treatment should be considered in the setting of impending or actual complications, for example, when the aortic diameter exceeds 55–60 mm, in the case of uncontrolled pain or blood pressure with evidence of malperfusion syndrome or rapid growth of the dissecting aneurysm (>1 cm/year). In both complicated acute and chronic type B aortic dissections, endovascular therapy may emerge as an attractive alternative to open surgery. However, in uncomplicated chronic type B aortic dissection, endovascular therapy failed to improve outcomes over optimal medical therapy within 2 years despite aortic remodeling. SUMMARYEndovascular stent-graft therapy for aortic dissection is emerging with good mid-term results. Further indications, that is, aortic arch dissection and uncomplicated acute aortic dissections, are under evaluation.