Endovascular procedures in type A aortic dissections. A review of the literature

Type A aortic dissection remains the last challenge of endovascular repair due to the complex anatomy of the ascending aorta and its proximity to the heart and the supra-aortic trunks that makes precise deployment of endografts an extremely difficult procedure. Currently, there are no endovascular devices specifically developed for this aortic region. Thus, open repair is the gold standard approach, but high-risk patients are not eligible for cardiac surgery because of the significant morbidity and mortality associated with these procedures. Therefore, development of a less invasive treatment is an issue that must be addressed. To our best knowledge, there are only a few cases of type A aortic dissections reported in the literature which have been successfully treated with a totally endovascular approach. Two recent CT-based practicability-studies encourage this new approach, describing it as a suitable option for 31-39% of patients. Although the available literature is scant and the experience limited, endovascular repair appears as a treatment option for type A aortic dissections, but further evaluation is mandatory.