title: Endovascular Repair of Type A Aortic Dissection: Current Experience and Technical Considerations.
abstract: Dissection of the ascending aorta, type A aortic dissection (TAAD), represents a surgical emergency with high morbidity and mortality. Current open surgical techniques, although state-of-the-art procedures and having improved outcomes for patients with TAAD over the last decades, confer significant risk of complications and death. Recently, endovascular techniques for repair of both the abdominal and thoracic aorta have gained acceptance within the vascular and cardiovascular surgical communities as a useful tool in select pathologies and patient populations. As development of endovascular technology proceeds ever closer to the aortic valve, thoracic endovascular repair for TAAD deserves special investigation. A comprehensive literature search for studies reporting outcomes of endovascular repair in the ascending aorta was performed. In this review, we compile the worldwide experience of thoracic endovascular repair for TAAD as well as imaging studies for patient selection and the use of hybrid (open plus endovascular) techniques. The authors discuss the remaining challenges that preclude its broader adoption in this role, namely patient selection and device specificity.
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Horton
authors.affiliation: University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
authors.affiliation: Aortic Center, Université Lille Nord de France, Lille, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Haulon
authors.affiliation: Department of Cardio-thoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Ali
authors.initials: A
authors.lastname: Khoynezhad
authors.affiliation: Department of Surgery, Columbia University Medical Center Surgery, New York, New York.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Green
authors.affiliation: Department of Surgery, Columbia University Medical Center Surgery, New York, New York.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Department of Surgery, Columbia University Medical Center Surgery, New York, New York. Electronic address: ffm2110@cumc.columbia.edu.
authors.forename: Firas F
authors.initials: FF
authors.lastname: Mussa
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: TEVAR; ascending aorta; endovascular; type A aortic dissection