Thoracic endovascular stent-graft therapy in aortic dissection.
OBJECTIVE
Aortic 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.


RESULTS
Uncomplicated 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.


CONCLUSIONS
Endovascular 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.
Akin
Ibrahim
I
Heart Center Rostock, Department of Internal Medicine I, University Hospital Rostock, Rostock School of Medicine I, Rostock, Germany.
Kische
Stephan
S
Rehders
Tim C
TC
Ince
Hüseyin
H
Nienaber
Christoph A
CA
D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000637:transplantation*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D012307:Risk Factors; D015607:Stents