Thoracic endovascular aneurysm repair for complicated type B aortic dissection.

Endovascular reconstruction of the true lumen by use of minimally invasive stent grafting or stenting is becoming increasingly popular and may have the potential to emerge as the first-line therapy for acute complicated type B dissection. Thoracic aortic dissection can be classified as complicated vs uncomplicated (stable), or anatomically according to the origin of the intimal tear or whether the dissection involves the ascending aorta. Although the outcomes of so-called complicated type B dissection are known to be disastrous with open surgery and disappointing with medical management alone, those patients with complications, such as organ malperfusion syndrome, impending rupture, ongoing pain, and resistant hypertension, may qualify preferentially for endovascular reconstruction of the true lumen. Cumulative extraction of currently available outcomes data and meta-analytic interpretation of the available observational evidence suggest that endovascular stent grafts provide improved survival in the setting of complicated type B dissection today.