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Editorials

Aortic Dissection Endovascular Stenting: Less Pain, Survival Gain?

Aorta Center and Marfan and Connective Tissue Disorder Clinic, The Cleveland Clinic Foundation, Cleveland, Ohio

^_* Address correspondence to Dr Svensson, Aorta Center, The Cleveland Clinic Foundation, 9500 Euclid Ave, F25, Cleveland, OH 44195 (Email: svenssl@ccf.org).

The first 20% of the full text of this article appears below.

The group from Buffalo [1] present an important series of patients in whom stents were inserted for distal aortic dissection and raise two questions: is there less pain and a survival gain for stenting aortic dissections? For acute dissections, in most centers, endovascular treatment is preferable for complications of acute aortic dissection, particularly ischemia. Hence, for acute dissection, the Society of Thoracic Surgeons and the multispecialty expert consensus and guidelines committee made this a class I (should be performed), level of evidence A, recommendation for endograft treatment (Table 12 [2]). For acute dissection with no complications, the guidelines were class II B (not recommended, may be considered) level of evidence B, although this requires further study. For subacute dissections, based on the INvestigation of STEnt grafts in patients with type B Aortic Dissection (INSTEAD) randomized trial [2], the recommendations are similar to those for acute dissection with no complications, because survival was better in the medically treated control arm in the INSTEAD trial. The guidelines also had the same recommendations (class II B, level of evidence B) for chronic aortic dissection (for symptomatic aneurysms or size > 5.5 cm).

This current article by Alves and colleagues [1] has one of the longest follow-up periods and raises further questions . . . [Full Text of this Article]

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Endovascular Treatment of Type B Aortic Dissection: The Challenge of Late Success

Claudia Maria Rodrigues Alves, José Honório Palma da Fonseca, José Augusto Marcondes de Souza, Hyung Chun Kim, Guilherme Esher, and Ênio Buffolo
Ann. Thorac. Surg. 2009 87: 1360-1365. [Abstract] [Full Text] [PDF]