Experience with Thoracic EndoVascular Aortic Repair (TEVAR) treatment of uncomplicated Stanford type B aortic dissection, 2022 Updates
Main Article Content
Abstract
There have been significant advances in the technique and application of endovascular repair of thoracic aortic pathology over the past 20 years. The Stanford type A and the complicated type B dissection patients require urgent/emergent intervention. In the last decade, earlier intervention has been pursued for uncomplicated type B dissections. The INvestigation of STent-grafts in Aortic Dissection (INSTEAD) Long term (XL) study showed that there was significant crossover from medical management to Thoracic EndoVascular Aortic Repair (TEVAR) at year 3, suggesting TEVAR might benefit this population long term.
Today, the application of TEVAR, which was initially designed to address aneurysmal disease, has become a standard and Food and Drug Administrative (FDA) approved management option in dissections.
Currently there are four FDA approved TEVAR devices in the United States for the treatment of the thoracic dissections, namely Gore, Medtronic, Cook, and Terumo. With each iteration, there are increased opportunities for customization and widespread use in individualized patient’s pathology. As the technology improves and the feasibility of the grafts expands, the complication rates continue to decline cementing the safety and efficacy of these thoracic aortic grafts. Two rare but catastrophic complications in spinal ischemia and retrograde Stanford type A aortic dissection are further discussed. With the success of the TEVAR, a new frontier of hybrid aortic surgery has developed. The debranching of the aortic arch vessels in order to advance the TEVAR proximal landing zones has been aggressively pursued. With the widespread growth of TEVAR technology it is apparent that complex aortic pathology can be safely repaired endovascularly.
Keywords:
Thoracic EndoVascular Aortic Repair (TEVAR), Uncomplicated Stanford type B aortic dissection, INvestigation of STent-grafts in Aortic Dissection (INSTEAD) Long term (XL) trial, GORE Comfort graft, Medtronic Valiant graft, Cook Zenith graft, Terumo Relay graft
Article Details
How to Cite
ALI, Amna et al.
Experience with Thoracic EndoVascular Aortic Repair (TEVAR) treatment of uncomplicated Stanford type B aortic dissection, 2022 Updates.
Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3353>. Date accessed: 21 nov. 2024.
doi: https://doi.org/10.18103/mra.v10i12.3353.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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19. Thrumurthy SG, Karthikesalingam A, Patterson BO, Holt PJ, Hinchliffe RJ, Loftus IM et al. A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg 2011; 42:632-47
20. Kamman AV, Brunkwall J, Verhoeven EL, et al.; ADSORB trialists. Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database. J Vasc Surg 2017; 65: 964-71.e3.
21. Demers P, Miller DC, Mitchell RS, Kee ST, Sze D, Razavi MK et al. Midterm results of endovascular repair of descending thoracic aortic aneurysms with first-generation stent grafts. J Thorac Cardiovasc Surg 2004; 127: 664-73.
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23. Makaroun MS, Dillavou ED, Kee ST, Sicard G, Chaikof E, Bavaria J et al. Endovascular treatment of thoracic aortic aneurysms, results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis. J Vasc Surg 2005; 41:1-9.
24. Panesar H, Simonian G, O'Connor D. GORE® TAG® conformable thoracic stent graft for the treatment of descending aortic pathologies. Future Cardiol. 2022 May;18(5):431-441
25. Squiers JJ, DiMaio JM, Schaffer JM et al. Surgical debranching versus branched endografting in zone 2 thoracic endovascular aortic repair. Journal of Vascular Surgery 2022; 75(6): 1829-1836.e3.
26. Fairman RM, Criado F, Farber M, Kwolek C, Mehta M, White R. et al. Pivotal results of the Medtronic Vascular Talent Thoracic Stent Graft System: The VALOR trial. J Vasc Surg 2008; 48:546-54.
27. Fairman RM, Tuchek JM, Lee WA, Kasirajah K, White R, Mehta M et al. Pivotal results for the Medtronic Valiant Thoracic Stent Graft System in the VALOR II trial. J Vasc Surg 2012; 56: 1222-31.
28. Criado FJ, Abul-Khoudoud OR, Domer GS, McKendrick C, Zuzga M, Clark NS et al. Endovascular repair of the thoracic aorta: lessons learned. Ann Thorac Surg 2005; 80: 857-63.
29. Zipfel B, Hammerschmidt R, Krabatsch T, Buz S, Weng Y, Hetzer R. Stent-grafting of the thoracic aorta by the cardiothoracic surgeon. Ann Thorac Surg 2007; 83: 441-9.
30. Torsello GF, Argyriou A, Stavroulakis K, Bosiers MJ, Austermann M, Torsello GB; SURPASS Registry Collaborators. One-Year Results From the SURPASS Observational Registry of the CTAG Stent-Graft With the Active Control System. J Endovasc Ther. 2020 Jun;27(3):421-427.
31.Morales JP, Greenberg RK, Morales CA, Cury M, Hernandez AV, Lyden SP et al. Thoracic aortic lesions treated with the Zenith TX1 and TX2 thoracic devices: intermediate and long-term outcomes. J Vasc Surg 2008; 48: 54-63.
32. Lombardi JV, Cambria RP, Nienaber CA, Chiesa R, Teebken O, Lee A. Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design. J Vasc Surg 2012; 55: 629-40.
33. Zipfel B, Hetzer R, Czerny M, Funovics M, Coppi G, Ferro C, et al. Endovascular treatment of patients with types A and B thoracic aortic dissection using Relay thoracic stent-grafts: results from the RESTORE Patient Registry. J Endovasc Ther 2011, 18: 131-43.
34. Baril DT, Cho JS, Chaer RA, Makaroun, MS. Thoracic Aortic Aneurysms and Dissections: Endovascular Treatment. Mt Sinai Jour of Med 2010; 77: 256-69
35. Svensson LG, Kouchoukos NT, Miller DC. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg 2008; 85:S1-41.
36. Carroccio A, Marin M, Ellozy S, Hollier LH. Pathophysiology of paraplegia following endovascular thoracic aortic aneurysm repair. J Card Surg. 2003; 18: 359-66
37. Khoynezhad A, Donayre CE, Bui H. Kopchok GE, Walot I, White RA. Risk factors of neurologic deficit after thoracic aortic endografting. Ann Thorac Surg 2007, 83: S882-9
38. Safi HJ, Estrera AL, Miller CC, Huynh TT, Porat EE, Azizzadeh A et al. Evolution of risk for neurologic deficit after descending and thoracoabdominal aortic repair. Ann Thorac Surg 2005; 80:2173-9
39. Mehta M, Hnath JC, Sternbach Y, Taggert JB, Kreienberg PB, Spirig A et al. Cerebrospinal fluid drainage during TEVAR. Endovascular Today 2008; 44-46.
40. Estrera AL, Sheinbaum R, Miller CC, Azizzadeh A, Walkes JC, Lee TY et al. Cerebrospinal fluid drainage during thoracic aortic repair: safety and current management. Ann Thorac Surg 2009; 88:9-15.
41. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation 2010; 121:e266-369.
42. Wynn MM, Mell MW, Tefera G, Hoch JR, Acher CW. Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008. J Vasc Surg 2009; 49: 29-35.
43. Eggebrecht H, Thompson M, Rousseau H Zerny M, Lonn L, Mehta RH et al. European registry on endovascular aortic repair complications: retrograde ascending aortic dissection during or after thoracic aortic stent graft placement. Circulation 2009; 120: S276-81.
44. Williams JB, Anderson ND, Bhattacharya SD, Scheer E, Piccini JP, McCann RL et al. Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair. J Vasc Surg 2012; 55:1255-1262.
45. Piffaretti G, Trimarchi S, Castelli P. Retrograde type A aortic dissection. Supplement to Endovascular today 2012: 18-22
46. Dong Z, Fu W, Wang Y, Wang C, Yan Z, Guo D et al. Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection. J Vasc surg 2010; 52: 1450-1457.
47. Savini C, Casselman F, Ergenoglu MU, Degrieck I, Van Praet F, De Geest R et al. Surgical management of progression to type A dissection from an intramural hematoma previously treated with endovascular stent graft placement. J Thorac Cardiovasc Surg. 2004; 128: 773-5.
48. Eagleton MJ, Greenberg RK. Hybrid procedures for the treatment of aortic arch aneurysms. J Cardiovasc Surg 2010, 51: 807-19.
49. Ramlawi B, Reardon MJ. Aortic arch debranching: advanced and hybrid techniques. Methodist Debakey Cardiovasc J. 2011; 7:43-7.
50. Chiesa R, Tshomba Y, Logaldo D, Civilini E, Bertoglio L, Melissano G. Hybrid Repair of Aortic aneurysms and Dissections. Tex Heart Inst J 2011; 38: 687-690.
51. Cao P, De Rango P, Czerny M, Evangelista A, Fattori R, Nienaber C et al. Systematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases. J thorac Cardiovasc Surg 2012; 144:1286-1300.
52. Thompson, M. Coming soon: TEVAR in the ascending aorta? Endovascular today 2011; 61-3.
53. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL et al. The international registry of acute aortic dissection (IRAD): new insight into an old disease. JAMA 2000; 283:897-903.
54. Sobocinski J, O’Brien N, Maurel B, Bartoli M, Goueffic Y, Sassard T, et al. Endovascular approaches to acute aortic type A dissection: a CT-based feasibility study. Eur J Vasc Endovasc Surg. 2011; 42: 442-7
55. Moon MC, Greenberg RK, Morales JP, Martin Z, Lu Q, Dowdall JF, Hernandez AV. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy. J Vasc Surg 2011; 53: 942-9.
56. Ye C, Chang G, Li S, Hu Z, Yao C, Chen W et al. Endovascular stent-graft treatment for Stanford type A aortic dissection. Eur J Vasc Endovasc Surg 2011; 42:787-94.
57. MacGillivray, T, Gleason, T, Patel H, Aldea G et al. The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the management of Type B aortic dissection. Ann Thorac Surg 2021; 11: 1-20.
2. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysm. Ann Vasc Surg 1991; 5:491-9.
3. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent grafts for the treatment of descending thoracic aortic aneurysm. N Engl J Med 1994; 331:1729-34
4. Sueyoshi E, Sakamoto I, Uetani M. Growth rate of affected aorta in patients with type B partially closed aortic dissection. Ann Thorac Surg 2009; 88: 1251-7
5. Winnerkvist A, Lockowandt U, Rasmussen E, Radegran K. A prospective study of medically treated acute type B aortic dissection. Eur J Vasc Endovasc Surg 2006; 32:356-7
6. Gysi J, Schaffner T, Mohacsi P, Aeschbacher B, Althaus U, Carrel T. Early and late outcome of operated and non-operated acute dissection of the descending aorta. Eur J Cardiothorac Surg 1997; 11: 1163-70
7. Roberts WC. Aortic dissection: anatomy, consequences, and causes. Am Heart J 1981; 101: 195-214.
8. Bernard Y, Zimmermann H, Chocron S, Litzier JF, Kastler B, Etievent JP et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol 2001; 87: 1378-82.
9. Akutsu K, Nejima J, Kiuchi K, Sasaki K, Ochi M, Tanaka K et al. Effects of the patent false lumen on the long term outcome of type B acute aortic dissection. Eur J Cardiothorac Surg 2004; 26: 359-66
10. Dake MD, Kato N, Mitchell RS, Semba CP, Razavi MK, Shimono T et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 1999; 340: 1546-52
11. Nienaber CA, Fattori R, Lund G, Dieckmann C, Wolf W, Von Kodolitsch Y et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 1999; 340:1539-45
12. Desai ND, Pochettino A, Szeto WY, Moser W, Moeller PJ, Sodhi N et al. Thoracic endovascular aortic repair: Evolution of therapy, patterns of use, and results in a 10-year experience. J Thorac Cardiovasc Surg 2011; 142: 587-93
13. Leurs LJ, Bell R, Degrieck Y, Thomas S, Hobo R, Lundobrn J. Endovascular treatment of thoracic aortic diseases; combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries. J Vasc Surg, 2004; 40 670-80.
14. Eggebrecht H, Nienaber CA, Neuhauser M, Baumgart D, Kische S, Schmermund A, et al. Endovascular stent-graft placement in aortic dissection: a meta analysis. Eur Heart J 2006; 27: 489-98
15. Kische S, Ehrlich MP, Nienaber CA, Rousseau H, Hejimen R, Pique P et al. Endovascular treatment of acute and chronic aortic dissection midterm results from the Talent Thoracic Retrospective Registry. Thorac Cardiovasc Surg 2009; 138: 115-24.
16. Nienaber CA, Rousseau H, Holger E, Kische S, Fattori R, Rehders TC et al. Randomized comparison of strategies for type B aortic dissection: the Investigation of STEnt Grafts in Aortic Dissection (INSTEAD) Trial. Circulation 2009; 120: 2519-28
17. Kwolek CJ, Watkins MT. The Investigation of STEnt Grafts in Aortic Dissection (INSTEAD) Trial. The Need for Ongoing Analysis. Circulation 2009; 120: 2513-14.
18. Nienaber CA, Kische S, Rousseau H, et al.; INSTEAD-XL trial. Endovascular repair of type B aortic dissection. Long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv 2013; 6: 407-16.
19. Thrumurthy SG, Karthikesalingam A, Patterson BO, Holt PJ, Hinchliffe RJ, Loftus IM et al. A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg 2011; 42:632-47
20. Kamman AV, Brunkwall J, Verhoeven EL, et al.; ADSORB trialists. Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database. J Vasc Surg 2017; 65: 964-71.e3.
21. Demers P, Miller DC, Mitchell RS, Kee ST, Sze D, Razavi MK et al. Midterm results of endovascular repair of descending thoracic aortic aneurysms with first-generation stent grafts. J Thorac Cardiovasc Surg 2004; 127: 664-73.
22. Bavaria, JE, Appoo JJ, Makaroun MS, Verter J, Yu ZF, Mitchell RS. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J Thorac Cardiovasc Surg 2007; 133: 369-77.
23. Makaroun MS, Dillavou ED, Kee ST, Sicard G, Chaikof E, Bavaria J et al. Endovascular treatment of thoracic aortic aneurysms, results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis. J Vasc Surg 2005; 41:1-9.
24. Panesar H, Simonian G, O'Connor D. GORE® TAG® conformable thoracic stent graft for the treatment of descending aortic pathologies. Future Cardiol. 2022 May;18(5):431-441
25. Squiers JJ, DiMaio JM, Schaffer JM et al. Surgical debranching versus branched endografting in zone 2 thoracic endovascular aortic repair. Journal of Vascular Surgery 2022; 75(6): 1829-1836.e3.
26. Fairman RM, Criado F, Farber M, Kwolek C, Mehta M, White R. et al. Pivotal results of the Medtronic Vascular Talent Thoracic Stent Graft System: The VALOR trial. J Vasc Surg 2008; 48:546-54.
27. Fairman RM, Tuchek JM, Lee WA, Kasirajah K, White R, Mehta M et al. Pivotal results for the Medtronic Valiant Thoracic Stent Graft System in the VALOR II trial. J Vasc Surg 2012; 56: 1222-31.
28. Criado FJ, Abul-Khoudoud OR, Domer GS, McKendrick C, Zuzga M, Clark NS et al. Endovascular repair of the thoracic aorta: lessons learned. Ann Thorac Surg 2005; 80: 857-63.
29. Zipfel B, Hammerschmidt R, Krabatsch T, Buz S, Weng Y, Hetzer R. Stent-grafting of the thoracic aorta by the cardiothoracic surgeon. Ann Thorac Surg 2007; 83: 441-9.
30. Torsello GF, Argyriou A, Stavroulakis K, Bosiers MJ, Austermann M, Torsello GB; SURPASS Registry Collaborators. One-Year Results From the SURPASS Observational Registry of the CTAG Stent-Graft With the Active Control System. J Endovasc Ther. 2020 Jun;27(3):421-427.
31.Morales JP, Greenberg RK, Morales CA, Cury M, Hernandez AV, Lyden SP et al. Thoracic aortic lesions treated with the Zenith TX1 and TX2 thoracic devices: intermediate and long-term outcomes. J Vasc Surg 2008; 48: 54-63.
32. Lombardi JV, Cambria RP, Nienaber CA, Chiesa R, Teebken O, Lee A. Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design. J Vasc Surg 2012; 55: 629-40.
33. Zipfel B, Hetzer R, Czerny M, Funovics M, Coppi G, Ferro C, et al. Endovascular treatment of patients with types A and B thoracic aortic dissection using Relay thoracic stent-grafts: results from the RESTORE Patient Registry. J Endovasc Ther 2011, 18: 131-43.
34. Baril DT, Cho JS, Chaer RA, Makaroun, MS. Thoracic Aortic Aneurysms and Dissections: Endovascular Treatment. Mt Sinai Jour of Med 2010; 77: 256-69
35. Svensson LG, Kouchoukos NT, Miller DC. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg 2008; 85:S1-41.
36. Carroccio A, Marin M, Ellozy S, Hollier LH. Pathophysiology of paraplegia following endovascular thoracic aortic aneurysm repair. J Card Surg. 2003; 18: 359-66
37. Khoynezhad A, Donayre CE, Bui H. Kopchok GE, Walot I, White RA. Risk factors of neurologic deficit after thoracic aortic endografting. Ann Thorac Surg 2007, 83: S882-9
38. Safi HJ, Estrera AL, Miller CC, Huynh TT, Porat EE, Azizzadeh A et al. Evolution of risk for neurologic deficit after descending and thoracoabdominal aortic repair. Ann Thorac Surg 2005; 80:2173-9
39. Mehta M, Hnath JC, Sternbach Y, Taggert JB, Kreienberg PB, Spirig A et al. Cerebrospinal fluid drainage during TEVAR. Endovascular Today 2008; 44-46.
40. Estrera AL, Sheinbaum R, Miller CC, Azizzadeh A, Walkes JC, Lee TY et al. Cerebrospinal fluid drainage during thoracic aortic repair: safety and current management. Ann Thorac Surg 2009; 88:9-15.
41. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation 2010; 121:e266-369.
42. Wynn MM, Mell MW, Tefera G, Hoch JR, Acher CW. Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008. J Vasc Surg 2009; 49: 29-35.
43. Eggebrecht H, Thompson M, Rousseau H Zerny M, Lonn L, Mehta RH et al. European registry on endovascular aortic repair complications: retrograde ascending aortic dissection during or after thoracic aortic stent graft placement. Circulation 2009; 120: S276-81.
44. Williams JB, Anderson ND, Bhattacharya SD, Scheer E, Piccini JP, McCann RL et al. Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair. J Vasc Surg 2012; 55:1255-1262.
45. Piffaretti G, Trimarchi S, Castelli P. Retrograde type A aortic dissection. Supplement to Endovascular today 2012: 18-22
46. Dong Z, Fu W, Wang Y, Wang C, Yan Z, Guo D et al. Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection. J Vasc surg 2010; 52: 1450-1457.
47. Savini C, Casselman F, Ergenoglu MU, Degrieck I, Van Praet F, De Geest R et al. Surgical management of progression to type A dissection from an intramural hematoma previously treated with endovascular stent graft placement. J Thorac Cardiovasc Surg. 2004; 128: 773-5.
48. Eagleton MJ, Greenberg RK. Hybrid procedures for the treatment of aortic arch aneurysms. J Cardiovasc Surg 2010, 51: 807-19.
49. Ramlawi B, Reardon MJ. Aortic arch debranching: advanced and hybrid techniques. Methodist Debakey Cardiovasc J. 2011; 7:43-7.
50. Chiesa R, Tshomba Y, Logaldo D, Civilini E, Bertoglio L, Melissano G. Hybrid Repair of Aortic aneurysms and Dissections. Tex Heart Inst J 2011; 38: 687-690.
51. Cao P, De Rango P, Czerny M, Evangelista A, Fattori R, Nienaber C et al. Systematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases. J thorac Cardiovasc Surg 2012; 144:1286-1300.
52. Thompson, M. Coming soon: TEVAR in the ascending aorta? Endovascular today 2011; 61-3.
53. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL et al. The international registry of acute aortic dissection (IRAD): new insight into an old disease. JAMA 2000; 283:897-903.
54. Sobocinski J, O’Brien N, Maurel B, Bartoli M, Goueffic Y, Sassard T, et al. Endovascular approaches to acute aortic type A dissection: a CT-based feasibility study. Eur J Vasc Endovasc Surg. 2011; 42: 442-7
55. Moon MC, Greenberg RK, Morales JP, Martin Z, Lu Q, Dowdall JF, Hernandez AV. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy. J Vasc Surg 2011; 53: 942-9.
56. Ye C, Chang G, Li S, Hu Z, Yao C, Chen W et al. Endovascular stent-graft treatment for Stanford type A aortic dissection. Eur J Vasc Endovasc Surg 2011; 42:787-94.
57. MacGillivray, T, Gleason, T, Patel H, Aldea G et al. The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the management of Type B aortic dissection. Ann Thorac Surg 2021; 11: 1-20.