Abstract
Background: Uncomplicated Stanford Type B aortic dissection
(un-TBAD) is characterised by a tear in the aorta distal to the left
subclavian artery without ascending aorta and arch involvement.
Optimised cardiovascular control (blood pressure and heart rate) is the
current gold standard treatment according to current international
guidelines. However, emerging evidence indicates that Thoracic
Endovascular Aortic Repair (TEVAR) is both safe and effective in the
treatment of un-TBAD with improved long-term survival outcomes in
combination with optimal medical therapy (OMT) relative to OMT alone.
However, the optimal timeframe for intervention is not entirely
clarified.
Aims: This review critically addresses current state-of-the-art
comparing TEVAR with OMT and corresponding clinical outcomes for un-TBAD
based on timing of intervention.
Methods: We carried out a comprehensive literature search on
multiple electronic databases including PUBMED and Scopus in order to
collate all research evidence on timing of TEVAR in uncomplicated Type B
aortic dissection.
Results: TEVAR has proven to be a safe and effective treatment
for un-TBAD in combination with OMT through comparable survival
outcomes, improved aortic remodelling, and relatively low periprocedural
added risks. Though the timing of intervention remains controversial, it
is becoming clear that performing TEVAR during the subacute phase of
un-TBAD yields better outcomes compared to earlier and delayed
(>90 days) intervention.
Conclusions: Further research is required into both short and
long-term outcomes of TEVAR in addition to its optimal therapeutic
window for un-TBAD. With stronger evidence, TEVAR is likely to be
adopted as the gold-standard intervention for un-TBAD with definitive
timeframe guidelines.