Thoracic aortic dissection: long-term results of endovascular and open repair.

Treatment paradigms for aortic dissection are based upon the types of complications with which the patients present. For acute uncomplicated dissection, medical therapy is preferred. Endovascular repair is preferred for patients with acute distal dissection complicated by end-organ malperfusion, rupture, or aneurysmal degeneration. For patients with chronic dissection with aneurysm, open repair is preferred if safe, and endovascular treatment should be limited to highest-risk patients because of the uncertainty of success with this approach. For intermediate-risk patients, hybrid repairs provide a good alternative. Ultimately, improvement in long-term outcomes after treatment of aortic dissection still depends on prevention of end-organ ischemia and aneurysmal degeneration of the chronically dissected distal aorta. Although the evidence base for the roles of various approaches is lacking, data currently being accrued and must be closely analyzed to better estimate both the short- and long-term benefits of these complementary treatment strategies.