Endovascular treatment of type Baortic dissection

Abstract

Endovascular technology and techniques are being rapidly applied to patients with acute and chronic dissections despite being an off-label indication. Multiple studies have shown morbidity and mortality benefit when comparing short- and midterm outcomes between open and endovascular repair. The goal with TEVAR, which is accomplished in greater than 90 %, is to cover the proximal intimomedial tear and reestablish preferential antegrade flow to the true lumen. This allows thrombosis of the false lumen in 80–95 %, decreased false lumen diameter in 79 %, and true lumen expansion in 66 %. Although TEVAR provides an effective repair with superior risk profile when compared with open repair, the rate of reintervention can reach 60 % due to endoleak, stent migration, stent-graft collapse, material fatigue, or propagation of the dissection. This chapter presents the endovascular treatment of type B aortic dissections.