Aneurysmal degeneration of type B aortic dissections after thoracic endovascular aortic repair: A systematic review

Background: Promising results of thoracic endovascular aortic repair (TEVAR) in patients with complicated type B aortic dissection (TBAD) have been well documented. However, whereas early results have led many to hypothesize a benefit of TEVAR in uncomplicated patients, the natural history of TEVAR after the treatment of TBAD has yet to mature. In this review, we evaluated the available data to investigate whether longer term TEVAR warrants enthusiasm for all comers with TBAD. Methods: A systematic review of the literature was performed searching specifically for studies assessing medium- and long- term outcomes after TEVAR for the treatment of TBAD. Studies were included if changes in aortic volume or diameter were recorded. Any publications recording only changes in mean aortic diameter across the study population were excluded. Results: A total of 17 studies examining growth in the thoracic aorta were included. This event occurred in 6.6% to 84% of patients across studies. Six studies examined growth in the abdominal aorta after TEVAR, which occurred in 10% to 54% of patients. When viewed by chronicity, a significant number of patients treated for chronic and acute dissection experienced aneurysmal degeneration. Conclusions: Based on the available data to date, TEVAR for TBAD does not prevent aneurysmal degeneration of the thoracic or abdominal aorta. Therefore, the treatment of uncomplicated patients with this goal in mind is currently contrary to the available data. Given the variability of manuscript reporting styles for TBAD, the development of reporting standards is necessary to homogenize available data and to strengthen our understanding of this complex disease process.