TEVAR for Acute Complicated Type B Aortic Dissection

Abstract

Thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of descending thoracic aortic aneurysms and has become the standard of care for treatment of type B aortic dissection complicated by organ malperfusion or rupture. Coverage of the primary intimal tear by the endograft eliminates antegrade false lumen perfusion and diverts all blood flow into the true lumen. This results in true lumen expansion and false lumen reduction and/or obliteration. In cases of dynamic malperfusion, TEVAR alone will resolve endorgan ischemia. Additional branch vessel stenting is required for cases of static malperfusion. A reproducible percutaneous method of TEVAR is described in which thoracic aortic stent grafting is performed from the left subclavian artery to the celiac artery with the use of intravascular ultrasound to repair acute type B aortic dissection. Salient technical aspects are described with illustrations demonstrating the key procedural steps.