Endovascular Management of Aortic Dissection

Aortic dissection arises when a tear in the intimal layer of the aorta permits blood to enter the medial wall, creating a true lumen and a parallel false lumen. Traditionally managed by open surgery, the advent of endovascular techniques has transformed care, particularly for type B dissections involving the descending aorta. Thoracic endovascular aortic repair (TEVAR) employs a stent-graft delivered via the femoral or iliac arteries to seal the primary entry tear, promote false lumen thrombosis and prevent aneurysmal dilatation or rupture. Patient selection hinges on anatomic suitability, timing relative to symptom onset and the presence of complications such as malperfusion or rapid aortic expansion. Technological refinements in stent-graft design, delivery systems and imaging guidance have broadened indications and improved perioperative safety. Long-term surveillance reveals favourable survival and reduced reintervention rates compared with open repair, though challenges remain in ensuring adequate distal seal zones and managing branch vessel involvement. Ongoing innovation focuses on branched and fenestrated grafts to preserve visceral perfusion and on bioresorbable materials to harmonise with native tissue mechanics. Endovascular management now stands as a global standard for many acute and chronic dissections, offering a less invasive approach with significant reductions in morbidity and mortality.

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Endovascular Management of Aortic Dissection publication trend

The graph below shows the total number of articles in endovascular management of aortic dissection across all publications each year (not limited to Nature Index journals).

Technical terms

Aortic dissection: Separation of the aortic wall layers due to an intimal tear, creating true and false lumina.

Endovascular repair: Minimally invasive treatment that uses intravascular devices to seal the dissection via a stent-graft.

Stent-graft: A fabric-covered metallic scaffold used to bridge the tear and redirect blood flow.

Intimal tear: A breach in the innermost layer of the aorta that initiates dissection.

True lumen: The original blood channel within the aorta.

False lumen: A secondary channel created by dissection, liable to pressurisation and thrombosis.

Thrombosis: Formation of a blood clot within the dissection, often critical for sealing the false lumen.

Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR): Imaging technique that captures time-resolved three-dimensional blood velocity data within vessels.

References

1. In Vivo Efficacy of an Adhesive Bioresorbable Patch to Treat Aortic Dissections. JACC Basic to Translational Science (2023).
2. False lumen pressure estimation in type B aortic dissection using 4D flow cardiovascular magnetic resonance: comparisons with aortic growth. Journal of Cardiovascular Magnetic Resonance (2021).
3. Location of Reentry Tears Affects False Lumen Thrombosis in Aortic Dissection Following TEVAR. Journal of Endovascular Therapy (2020).
4. Endovascular treatment of chronic aortic dissection with fenestrated and branched stent grafts. Journal of Vascular Surgery (2020).