[Current status and challenges of endovascular repair for Stanford type A aortic dissection].

ABSTRACT

Type A aortic dissection (TAAD) is characterized by acute onset, high mortality and high surgical risks.Although open surgery has been the first-line treatment for TAAD in current guidelines, 10% to 30% of them will accept conservative treatment due to the high risk of open surgery.In recent years, with the rapid progress of endovascular technology and the innovations of various devices, endovascular repair for TAAD has shown encouraging preliminary results.Thoracic endovascular aortic repair (TEVAR) has become the first-line treatment for complicated type B aortic dissection (TABD).By sealing the primary entry tear and promoting the remodeling of the false lumen, TEVAR is more minimally invasive and efficient compared to open repair.Compared with TBAD, TEVAR for TAAD is not fully elucidated.The primary entry tear is located in the ascending aorta, which has different pathophysiology characteristics from that in TBAD.More suitable and safe stent-graft and delivery system are needed. In terms of technology, the selection of proximal and distal landing zone and intraoperative brain protection are still the key and difficult problems. At the same time, there is a lack of mature programs in the treatment of the aortic root and the reconstruction of the aortic arch branches.