Endovascular ascending aortic repair in type A dissection: A systematic review

J Card Surg. 2021 Jan;36(1):268-279. doi: 10.1111/jocs.15192. Epub 2020 Nov 10.


Purpose: Up to 10% of acute type A aortic dissection (TAAD) patients are deemed unfit for open surgical repair, exposing these patients to high mortality rates. In recent years, thoracic endovascular aortic repair has proven to be a promising alternative treatment modality in specific cases. This study presents a comprehensive overview of the current state of catheter-based interventions in the setting of primary TAAD.

Methods: A literature search was conducted, using MEDLINE and PubMed databases according to PRISMA guidelines, updated until January 2020. Articles were selected if they reported on the endovascular repair of DeBakey Type I and II aortic dissections. The exclusion criteria were retrograde type A dissection, hybrid procedures, and combined outcome reporting of mixed aortic pathologies (e.g., pseudoaneurysm and intramural hematoma).

Results: A total of 31 articles, out of which 19 were case reports and 12 case series, describing a total of 92 patients, were included. The median follow-up was 6 months for case reports and the average follow-up was 14 months for case series. Overall technical success was 95.6% and 30-day mortality of 9%. Stroke and early endoleak rates were 6% and 18%, respectively. Reintervention was required in 14 patients (15%).

Conclusion: This review not only demonstrates that endovascular repair in the setting of isolated TAAD is feasible with acceptable outcomes at short-term follow-up, but also underlines a lack of mid-late outcomes and reporting consistency. Studies with longer follow-up and careful consideration of patient selection are required before endovascular interventions can be widely introduced.

Keywords: ascending aorta; stent graft; systematic review; thoracic endovascular aortic repair; type A dissection.

Publication types

  • Systematic Review

MeSH terms

  • Aortic Aneurysm, Thoracic* / surgery
  • Blood Vessel Prosthesis Implantation*
  • Dissection
  • Endovascular Procedures*
  • Humans
  • Retrospective Studies
  • Risk Factors
  • Stents
  • Treatment Outcome