All type B aortic dissections should undergo thoracic endovascular aneurysm repair

Abstract

Central MessageEndovascular therapy has emerged as a preferred treatment option for acute complicated type B aortic dissection. Evidence is evolving to justify its application in uncomplicated and chronic stages. Endovascular therapy has emerged as a preferred treatment option for acute complicated type B aortic dissection. Evidence is evolving to justify its application in uncomplicated and chronic stages. With rapid advances in thoracic endovascular aneurysm repair (TEVAR) technology, and with increasing adoption of this procedure by the cardiovascular community, its role in the management of type B aortic dissection (TBAD) continues to evolve. Traditionally, medical management with anti-impulse therapy has been advocated for TBAD. In a retrospective study of 100 consecutive patients with TBAD, the early survival rate was as high as 91%.1Elefteriades J.A. Lovoulos C.J. Coady M.A. Tellides G. Kopf G.S. Rizzo J.A. Management of descending aortic dissection.Ann Thorac Surg. 1999; 67 (discussion 2014-9): 2002-2005Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar This study also reported that 66% of these survivors had an uncomplicated long-term course with anti-impulse therapy. However, the 5-year survival of patients with TBAD receiving the best medical treatment (BMT) is only 60% to 80%.2Glower D.D. Fann J.I. Speier R.H. Morrison L. White W.D. Smith L.R. et al.Comparison of medical and surgical therapy for uncomplicated descending aortic dissection.Circulation. 1990; 82: 39-46Google Scholar Continued degeneration of the aorta and resulting dilatation of the false lumen have been responsible for this suboptimal long-term result. We know that the descending thoracic aorta (DTA) growth rate exceeds that of the ascending aorta and that the dissected aorta tends to degenerate quicker than an aneurysmal aorta,3Davies R.R. Goldstein L.J. Coady M.A. Tittle S.L. Rizzo J.A. Kopf G.S. et al.Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size.Ann Thorac Surg. 2002; 73 (discussion 27-8): 17-27Abstract Full Text Full Text PDF PubMed Scopus (723) Google Scholar resulting from dilatation of false lumen, which can be seen in 50% of patients with TBAD over 5 years.4Nagai M. Makita S. Abiko A. Nakamura M. Factors related to long-term prognosis in medically treated type B aortic dissection: a physical predisposing factor.Int Angiol. 2012; 31: 427-432PubMed Google Scholar Aortic rupture, however less common in TBAD compared with type A aortic dissection, remains the most common cause of mortality in TBAD.5Gallo A. Davies R.R. Coe M.P. Elefteriades J.A. Coady M.A. Indications, timing, and prognosis of operative repair of aortic dissections.Semin Thorac Cardiovasc Surg. 2005; 17: 224-235Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar The incidence of aortic rupture increases up to 30% per year when the aortic diameter reaches 6 cm.5Gallo A. Davies R.R. Coe M.P. Elefteriades J.A. Coady M.A. Indications, timing, and prognosis of operative repair of aortic dissections.Semin Thorac Cardiovasc Surg. 2005; 17: 224-235Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar These findings speak to the persistent, long-term morbidity and mortality associated with the TBAD event. Expert consensus has been to have a “complication-specific” approach when treating TBAD mainly because of the benign natural history of a major subgroup of patients with TBAD,6Fattori R. Cao P. De Rango P. Czerny M. Evangelista A. Nienaber C. et al.Interdisciplinary expert consensus document on management of type B aortic dissection.J Am Coll Cardiol. 2013; 61: 1661-1678Crossref PubMed Scopus (298) Google Scholar,7Svensson L.G. Kouchoukos N.T. Miller D.C. Bavaria J.E. Coselli J.S. Curi M.A. et al.Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts.Ann Thorac Surg. 2008; 85: S1-S41Abstract Full Text Full Text PDF PubMed Scopus (702) Google Scholar and poor results after open repair. Pooled operative mortality after open repair of TBAD is 17.5%, with an increase to 30% in complicated TBAD cases, and reaches up to 50% in the presence of malperfusion.8Trimarchi S. Nienaber C.A. Rampoldi V. Myrmel T. Suzuki T. Bossone E. et al.Role and results of surgery in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD).Circulation. 2006; 114: I357-I364PubMed Google Scholar In a review of 1129 consecutive patients with TBAD from the International Registry of Acute Aortic Dissection, in which 853 patients received medical treatment and 276 patients underwent TEVAR, in-hospital mortality (8.7% vs 10.9%; P = .273) and 1-year mortality (9.8% vs 8.1%; P = .604) were similar between the 2 treatment groups.9Fattori R. Montgomery D. Lovato L. Kische S. Di Eusanio M. Ince H. et al.Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD).JACC Cardiovasc Interv. 2013; 6: 876-882Crossref PubMed Scopus (269) Google Scholar The TEVAR group at presentation had more in-hospital morbidity with an increased incidence of acute kidney injury (medical 12.5% vs TEVAR 25.3%; P = .016) and extension of dissection (5.8% vs 10.2%; P < .001). This review, which had a significantly greater number of patients with complicated dissections in the TEVAR group (37.2% vs 61.7%), showed a significant decrease in the size of DTA with TEVAR at 5-year follow-up. Aortic remodeling after TEVAR translated into less death rate in the TEVAR group at 5 years (29% vs 15.5%; P = .018). There was no difference between the 2 groups in the incidence of new dissection, extension of dissection, or late intervention. Five-year results of the INSTEAD XL (Investigation of Stent Grafts in Aortic Dissection) trial, a randomized trial comparing medical management with additional TEVAR in patients with uncomplicated TBAD, showed significant reduction in aorta-specific mortality in the TEVAR group (TEVAR: 0% vs medical treatment: 16.9%; P < .0005).10Nienaber C.A. Kische S. Rousseau H. Eggebrecht H. Rehders T.C. Kundt G. et al.Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial.Circ Cardiovasc Interv. 2013; 6: 407-416Crossref PubMed Scopus (627) Google Scholar Encouraging long-term results of these investigations underscore the potential of TEVAR in TBAD management. In this review, we make an argument for the role of TEVAR in patients with TBAD at various stages of the disease. Patients experience the greatest morbidity and mortality rates in the acute phase, classified as the first 2 weeks after TBAD onset.11Tsai T.T. Trimarchi S. Nienaber C.A. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD).Eur J Vasc Endovasc Surg. 2009; 37: 149-159Abstract Full Text Full Text PDF PubMed Scopus (317) Google Scholar,12Winnerkvist A. Lockowandt U. Rasmussen E. Rådegran K. A prospective study of medically treated acute type B aortic dissection.Eur J Vasc Endovasc Surg. 2006; 32: 349-355Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar The Acute Dissection Stent Grafting or Best Medical Treatment trial (ADSORB trial) is the only prospective randomized trial comparing TEVAR with BMT in patients with acute uncomplicated TBAD.13Brunkwall J. Kasprzak P. Verhoeven E. Heijmen R. Taylor P. Alric P. et al.Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial.Eur J Vasc Endovasc Surg. 2014; 48: 285-291Abstract Full Text Full Text PDF PubMed Scopus (207) Google Scholar In this trial, after intention-to-treat analysis at the end of 1 year, none of BMT group subjects failed to reach the primary end point of freedom from false lumen thrombosis (partial or none) and aortic dilatation, compared with 50% of patients in the TEVAR from thrombosis of the false lumen in TBAD is as false lumen is associated with increased aortic growth and S. Nienaber C.A. Rampoldi V. Myrmel T. Suzuki T. Bossone E. et al.Role and results of surgery in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD).Circulation. 2006; 114: I357-I364PubMed Google S. T.T. et of false lumen thrombosis in type B aortic dissection Thorac Cardiovasc Surg. 2013; Full Text Full Text PDF PubMed Scopus Google Scholar This trial, which was to mortality remodeling of DTA in the TEVAR false lumen diameter by an of compared with an increase of in the BMT group < .001). lumen diameter also showed an increase of in the TEVAR group compared with an increase of in the BMT group = diameter of DTA also showed of in the TEVAR This trial, in which 50% of subjects of and of patients in this study were type showed the with TEVAR in acute uncomplicated TBAD. is that patients with type TBAD have a prognosis than type G. of thrombosis in the false lumen after endovascular treatment of acute type B aortic dissection.J Vasc Surg. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar A retrospective analysis of of acute uncomplicated TBAD patients receiving BMT or TEVAR showed a greater incidence of early in the TEVAR D. H. L. et al.Comparison of of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection.J Thorac Cardiovasc Surg. Full Text Full Text PDF PubMed Scopus Google Scholar This was mainly by a greater incidence of type and type A dissection (TEVAR: The of TEVAR in acute TBAD was by the to the primary in of patients with a stent There was no report of or in the mortality was significantly between the 2 groups (TEVAR: vs P = the mortality in the in BMT group was to aortic Five-year analysis of the showed a significant survival in the TEVAR group from death at 5 TEVAR vs BMT P = in the TEVAR group was mainly by freedom from death at 5 years vs BMT P = incidence of rupture at 5 years was also greater in the BMT group vs BMT P = the groups had a incidence of type A dissection and new dissection. rate greater in the BMT was significant (TEVAR: vs BMT P = There were reported in the BMT group after the late compared with none in TEVAR This study showed the long-term survival of TEVAR in uncomplicated acute TBAD. and G. et al.Endovascular repair compared with medical management of patients with uncomplicated type B acute aortic dissection.J Am Coll Cardiol. PubMed Scopus Google Scholar in retrospective study of patients with acute uncomplicated TBAD TEVAR or also showed similar early survival in the The TEVAR group had a greater incidence of early mainly by type This study increased incidence of aortic rupture in the BMT group in the (TEVAR: none vs and at 5-year (TEVAR: vs The BMT group also greater mortality at 5 years rate from vs P = and greater incidence of (TEVAR: vs P = in 30% of patients at long-term follow-up. and C.A. D. Miller et of and mortality in patients with uncomplicated acute type B aortic dissection.J Vasc Surg. Full Text Full Text PDF PubMed Scopus Google Scholar in review of patients with uncomplicated TBAD, reported aortic diameter greater than < to be a for mortality over an of also reported false lumen diameter greater than to be a significant for of the lumen was to be associated with increased aortic growth rate in a retrospective review of patients with acute TBAD were medically J.A. et of aortic dilatation in type B aortic dissection.J Vasc Surg. 2013; Full Text Full Text PDF PubMed Scopus Google Scholar and J.A. et of aortic dilatation in type B aortic dissection.J Vasc Surg. 2013; Full Text Full Text PDF PubMed Scopus Google Scholar also reported of with increased aortic growth rate in patients with TBAD when compared with patients with 2 or Trimarchi S. J.A. et of is associated with aortic growth in type B Thorac Surg. 2013; Full Text Full Text PDF PubMed Scopus Google Scholar or on the has also been to be associated with increased aortic growth rate on C.A. Kische S. Rousseau H. Eggebrecht H. Rehders T.C. Kundt G. et al.Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial.Circ Cardiovasc Interv. 2013; 6: 407-416Crossref PubMed Scopus (627) Google Scholar TBAD is complicated is of rupture or Bavaria J.E. et for and of for type B aortic Vasc Surg. Full Text Full Text PDF PubMed Scopus Google Scholar In to 30% of TBAD is complicated and high mortality in the T.T. Trimarchi S. Nienaber C.A. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD).Eur J Vasc Endovasc Surg. 2009; 37: 149-159Abstract Full Text Full Text PDF PubMed Scopus (317) Google M.A. J.S. et management of descending thoracic aortic open and endovascular a from the PubMed Scopus Google Scholar surgical repair for complicated TBAD has an operative mortality of to which can be as high as 50% in the presence of M. K. A. A. J. and long-term results of of the descending J Vasc Endovasc Surg. 2005; Full Text Full Text PDF PubMed Scopus (23) Google Scholar A number of in the DTA than ascending aorta to increased after open A. Davies R.R. Coe M.P. Elefteriades J.A. Coady M.A. Indications, timing, and prognosis of operative repair of aortic dissections.Semin Thorac Cardiovasc Surg. 2005; 17: 224-235Abstract Full Text Full Text PDF PubMed Scopus (23) Google R. Cao P. De Rango P. Czerny M. Evangelista A. Nienaber C. et al.Interdisciplinary expert consensus document on management of type B aortic dissection.J Am Coll Cardiol. 2013; 61: 1661-1678Crossref PubMed Scopus (298) Google Scholar of to the of the in most to the of the In review of patients open repair for complicated acute TBAD, and R. T.T. Myrmel T. Evangelista A. Trimarchi S. et acute type B dissection: is surgery the best A report from the International Registry of Acute Aortic Cardiovasc Interv. 2008; PubMed Scopus Google Scholar reported in-hospital The incidence of was with a rate of poor survival with only medical treatment and a high rate of mortality and morbidity after open surgical TEVAR is the in patients with acute complicated R. Cao P. De Rango P. Czerny M. Evangelista A. Nienaber C. et al.Interdisciplinary expert consensus document on management of type B aortic dissection.J Am Coll Cardiol. 2013; 61: 1661-1678Crossref PubMed Scopus (298) Google M. J. R. Czerny M. Eggebrecht H. et endovascular aortic repair (TEVAR) for the treatment of aortic a from the for and the of in with the of J. 2012; PubMed Scopus Google Scholar The of TEVAR in patients with acute complicated TBAD was by and M.P. J. M. R. J. A. et results after endovascular treatment of complicated type B aortic dissection.Ann Thorac Surg. Full Text Full Text PDF PubMed Scopus Google Scholar in review of patients with of primary in of A review of patients TEVAR for acute complicated TBAD reported mortality of Pooled mortality for patients receiving BMT was J. T. Management of complicated and uncomplicated acute type B dissection. A review and Surg. 2014; Google Scholar and endovascular treatment for complicated type B aortic Cardiovasc 2005; 2 PubMed Scopus Google Scholar the of extension of a with a stent to false lumen to the stent to the lumen and aortic Nienaber and C.A. Kische S. T. Rehders T.C. H. et extension to after in type B aortic dissection: the Endovasc 2006; PubMed Scopus Google Scholar a of patients with or extension of TEVAR stent with a stent to lumen and false a rate and as the of using a stent to a for the of the of Aortic B Dissection trial, a prospective study of Dissection Endovascular for the treatment of patients with acute complicated TBAD, reported an mortality of only and rate of Nienaber C.A. R. P. S. et remodeling after endovascular treatment of complicated type B aortic dissection with the of a Vasc Surg. 2014; Full Text Full Text PDF PubMed Scopus Google Scholar The was a of a and a In this trial, a stent was only when was of or in the false lumen after of the to the primary Five-year results of the study showed freedom from mortality and freedom from Nienaber C.A. R. P. S. et results from the of Aortic B Dissection study of endovascular treatment of complicated type B aortic dissection using a Vasc Surg. Full Text Full Text PDF PubMed Scopus Google Scholar false lumen thrombosis of the thoracic aorta was in of patients at 5 and this translated into a significant increase in lumen diameter and a decrease in the size of the false aortic remodeling in this study was also from and 5-year freedom from and aortic rupture and J. R. M. A. and long-term after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection.Eur J Vasc Endovasc Surg. Full Text Full Text PDF PubMed Scopus Google Scholar in review of patients TEVAR for complicated TBAD, reported that 1 in 6 patients rupture, or rapid aortic more than after the of of the the first after the of be a to the of a in the natural history of TBAD. The is to from 2 weeks to from the of when the is and the is at of rapid disease M. M. a new approach to the of aortic dissection.Eur J Vasc Endovasc Surg. 2013; Full Text Full Text PDF PubMed Scopus Google Scholar In a review of patients underwent TEVAR for the of in the phase, was no report of which be to and of the this J. M. D. A. T. M. between acute and chronic type B aortic dissection: is a J Vasc Endovasc Surg. 2013; Full Text Full Text PDF PubMed Scopus Google Scholar In this study by and was no report of early death or after is that with of the with of aortic remodeling with TEVAR also this is for chronic dissection, which mainly by false lumen TEVAR in the has been to aortic remodeling by false lumen C.A. Kische S. Rousseau H. Eggebrecht H. R. et for type B aortic dissection: the investigation of stent grafts in patients with type B aortic dissection trial 1-year Thorac Cardiovasc Surg. (discussion Full Text Full Text PDF PubMed Scopus Google Scholar INSTEAD trial, patients with uncomplicated TBAD in the were randomized to only BMT or BMT with TEVAR, the of TEVAR in the There was no mortality and was in the A. Lockowandt U. Rasmussen E. Rådegran K. A prospective study of medically treated acute type B aortic dissection.Eur J Vasc Endovasc Surg. 2006; 32: 349-355Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar In of patients in the study had type TBAD, and of was in of Five-year results of this trial after intention-to-treat analysis reported significantly greater freedom from the point of and in the TEVAR group and the P = C.A. Kische S. Rousseau H. Eggebrecht H. Rehders T.C. Kundt G. et al.Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial.Circ Cardiovasc Interv. 2013; 6: 407-416Crossref PubMed Scopus (627) Google Scholar This study also showed the of disease in the TEVAR group after 2 This of disease in the TEVAR group was associated with aortic TEVAR group significant of lumen and of the false lumen in the TEVAR group also showed thrombosis of the false lumen in of at the thoracic and aortic remodeling in of This study showed to the natural history of TBAD by aortic remodeling and incidence of late in the TEVAR after the first year, compared with the BMT subjects and A. Lockowandt U. Rasmussen E. Rådegran K. A prospective study of medically treated acute type B aortic dissection.Eur J Vasc Endovasc Surg. 2006; 32: 349-355Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar reported survival of at years in patients with uncomplicated TBAD on anti-impulse therapy. degeneration of the aorta with an of to 50% of the false lumen by years was responsible for this suboptimal A review of patients from the underwent TEVAR for chronic TBAD reported an in-hospital mortality rate of K. L.R. G. A. of thoracic endovascular aortic repair for chronic aortic Vasc Surg. Full Text Full Text PDF PubMed Scopus Google Scholar and of TEVAR in patients with chronic TBAD was also from a of which reported in of A. et review of of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection.Eur J Vasc Endovasc Surg. Full Text Full Text PDF PubMed Scopus Google Scholar a of and injury were at and The INSTEAD trial, the only randomized trial of patients with uncomplicated TBAD underwent TEVAR between 2 and weeks after of also reported in the primary and had no C.A. Kische S. Rousseau H. Eggebrecht H. R. et for type B aortic dissection: the investigation of stent grafts in patients with type B aortic dissection trial 1-year Thorac Cardiovasc Surg. (discussion Full Text Full Text PDF PubMed Scopus Google Scholar A of TEVAR with open surgical repair in patients with chronic TBAD reported significantly early and with M. L. et al.Endovascular open repair for chronic type B dissection treatment: a Thorac Surg. Full Text Full Text PDF PubMed Scopus Google Scholar The for has been an after TEVAR in patients with chronic TBAD. In a retrospective review of patients with chronic dissection, and M. J. M. et of aortic after thoracic endovascular aortic repair on long-term Thorac Surg. Full Text Full Text PDF PubMed Scopus Google Scholar reported rate of in the false lumen is responsible for degeneration to the of the DTA and is a major for aortic and new were responsible for of the false lumen in of The incidence of was as high as in this was to significantly aortic remodeling in a review of patients with chronic TBAD receiving TEVAR, the incidence of was The of stent new on aortic remodeling of chronic type B dissection.Ann Thorac Surg. Full Text Full Text PDF PubMed Scopus (23) Google Scholar of the in patients with chronic TBAD has been to cause the more than and the for is also a significant However, in a prospective study of TEVAR and BMT in patients with chronic TBAD, and S. et results of stent therapy for chronic type B dissection.J Vasc Surg. 2013; Full Text Full Text PDF PubMed Scopus Google Scholar reported a incidence of type after TEVAR with in most patients follow-up. in this 5-year results of the INSTEAD reported greater freedom from the point of and C.A. Kische S. Rousseau H. Eggebrecht H. Rehders T.C. Kundt G. et al.Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial.Circ Cardiovasc Interv. 2013; 6: 407-416Crossref PubMed Scopus (627) Google Scholar The number to in this study was TEVAR group in the trial, of dissections were type showed aortic remodeling with the significant of the lumen in DTA to at 5 P < which was associated with significant in false lumen diameter to at 5 P < In the medical treatment group showed of aortic diameter to P < TEVAR group also showed a greater rate of false lumen thrombosis of DTA (TEVAR: P < of aortic remodeling in the BMT group translated into and the for intervention. of of TEVAR to aortic remodeling in chronic TBAD from a study from and et remodeling after endovascular repair with stent in acute and chronic type B aortic dissection.J Vasc Surg. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar in a retrospective study of patients with TBAD receiving TEVAR, was no significant difference in the rate of false lumen thrombosis between patients with acute and chronic TBAD acute P = these results a potential of TEVAR in subjects with chronic TBAD. for treatment after TEVAR in patients with chronic TBAD is of false lumen This has been as false lumen as per for of for G. et al.Endovascular repair compared with medical management of patients with uncomplicated type B acute aortic dissection.J Am Coll Cardiol. PubMed Scopus Google Scholar have been to false lumen thrombosis in this as we know that false lumen is associated with treatment S. Nienaber C.A. Rampoldi V. Myrmel T. Suzuki T. Bossone E. et al.Role and results of surgery in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD).Circulation. 2006; 114: I357-I364PubMed Google Scholar and J. et of endovascular false lumen on thoracic aortic remodeling in chronic dissection.Ann Thorac Surg. Full Text Full Text PDF PubMed Scopus Google Scholar in a report of patients false lumen for false lumen using and showed of false lumen thrombosis in of and T. C. A. false lumen in chronic aortic dissection: the Endovasc 2014; PubMed Scopus Google Scholar showed the and of an in a of patients an stent to rupture the dissection and the false and A. T. G. M. et for false lumen in chronic aortic dissection: and early Endovasc PubMed Scopus Google Scholar from the also a of consecutive patients with false lumen and showed in of is a stent a and has a which and the false lumen as the is However, these in with application in and more follow-up. In a review of patients with TBAD from the International Registry of Acute Aortic Dissection and T.T. et of extension in acute type B aortic dissection on management and Thorac Surg. Full Text Full Text PDF PubMed Scopus Google Scholar reported incidence of The of and after TEVAR for TBAD continues to be a of after TEVAR is P. D. R. P. and of in repair of the thoracic J Vasc Endovasc Surg. 2008; Full Text Full Text PDF PubMed Scopus Google Scholar and procedure per can be associated with V. L. G. P. and related in endovascular management of B dissection: and Surg. 2014; Google Scholar TEVAR is also a for and rates can be as high as in patients with 2 S. C. et in 2 thoracic endovascular aortic repair is associated with aortic Vasc Surg. Full Text Full Text PDF PubMed Scopus Google Scholar Acute increase in as a of stent in DTA has been to increase the on the J. T. Management of complicated and uncomplicated acute type B dissection. A review and Surg. 2014; Google Scholar Evidence of the of TEVAR in patients with TBAD is with TEVAR has to be to open repair for patients with acute complicated TBAD, and is a 1 A on the most of is a in the R. V. C. Bossone E. Eggebrecht H. et on the and treatment of aortic document acute and chronic aortic of the thoracic and aorta of the The for the and treatment of aortic of the of J. 2014; PubMed Scopus Google Scholar have the and of TEVAR in the acute in patients with uncomplicated TBAD. TEVAR can in the acute when is and to of the lumen and of the primary can aortic remodeling in the of This can be as early as year after TEVAR, as reported in the results of the ADSORB TEVAR has been to results in patients with uncomplicated TBAD. However, is no of BMT TEVAR for acute uncomplicated TBAD. ADSORB was with to This type of trial is

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