Critical Review of Guidelines for Type B Aortic Dissection

Mario D'Oria; Jacob Budtz-Lilly; Kevin Mani; Peter Legeza; Gabriele Piffaretti; Mohamad Bashir; Matti Jubouri; Giovanni Tinelli; Salvatore Scali

doi:10.1016/j.avsg.2025.01.002

Critical Review of Guidelines for Type B Aortic Dissection

Mario D'Oria^*, Jacob Budtz-Lilly, Kevin Mani, Peter Legeza, Gabriele Piffaretti, Mohamad Bashir, Matti Jubouri, Giovanni Tinelli, Salvatore Scali

^*Corresponding author for this work

Department of Clinical Medicine - Department of Cardiothoracic and Vascular Surgery

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Review › Research › peer-review

Abstract

The management of type B aortic dissection is one of the most challenging and debated topics in contemporary cardiovascular surgery practice. Patients with acute or chronic dissection-related complications face high morbidity and mortality if not treated promptly. For most patients requiring intervention, thoracic endovascular aortic repair (TEVAR) is considered the gold standard. However, both early and late TEVAR-related complications make decision-making complex, even for experienced clinicians. In many cases, optimal medical management with longitudinal imaging surveillance may be preferred. In response to these challenges, several societal guidelines have recently been published to provide evidence-based or expert consensus “best practice” recommendations. Although these guidelines share many commonalities, they also highlight key unresolved clinical questions. For example, debates persist over the appropriate use of TEVAR for “uncomplicated” TBAD, defining “high-risk” criteria for uncomplicated presentations, and management of the false lumen, among other topics. Despite recent updates, a critical evaluation of the nuanced differences between these guidelines is lacking. Therefore, the purpose of this review is to compare current clinical practice guidelines, highlight their similarities and differences, and offer a comprehensive evaluation of the evidence surrounding management of TBAD. Moreover, this analysis will provide recommendations to address important knowledge gaps.

Original language	English
Journal	Annals of Vascular Surgery
ISSN	0890-5096
DOIs	https://doi.org/10.1016/j.avsg.2025.01.002
Publication status	E-pub / Early view - 2025

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@article{92eaeaa0c5314850a0e1527076328104,

title = "Critical Review of Guidelines for Type B Aortic Dissection",

abstract = "The management of type B aortic dissection is one of the most challenging and debated topics in contemporary cardiovascular surgery practice. Patients with acute or chronic dissection-related complications face high morbidity and mortality if not treated promptly. For most patients requiring intervention, thoracic endovascular aortic repair (TEVAR) is considered the gold standard. However, both early and late TEVAR-related complications make decision-making complex, even for experienced clinicians. In many cases, optimal medical management with longitudinal imaging surveillance may be preferred. In response to these challenges, several societal guidelines have recently been published to provide evidence-based or expert consensus “best practice” recommendations. Although these guidelines share many commonalities, they also highlight key unresolved clinical questions. For example, debates persist over the appropriate use of TEVAR for “uncomplicated” TBAD, defining “high-risk” criteria for uncomplicated presentations, and management of the false lumen, among other topics. Despite recent updates, a critical evaluation of the nuanced differences between these guidelines is lacking. Therefore, the purpose of this review is to compare current clinical practice guidelines, highlight their similarities and differences, and offer a comprehensive evaluation of the evidence surrounding management of TBAD. Moreover, this analysis will provide recommendations to address important knowledge gaps.",

author = "Mario D'Oria and Jacob Budtz-Lilly and Kevin Mani and Peter Legeza and Gabriele Piffaretti and Mohamad Bashir and Matti Jubouri and Giovanni Tinelli and Salvatore Scali",

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year = "2025",

doi = "10.1016/j.avsg.2025.01.002",

language = "English",

journal = "Annals of Vascular Surgery",

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AU - D'Oria, Mario

AU - Budtz-Lilly, Jacob

AU - Mani, Kevin

AU - Legeza, Peter

AU - Piffaretti, Gabriele

AU - Bashir, Mohamad

AU - Jubouri, Matti

AU - Tinelli, Giovanni

AU - Scali, Salvatore

PY - 2025

Y1 - 2025

N2 - The management of type B aortic dissection is one of the most challenging and debated topics in contemporary cardiovascular surgery practice. Patients with acute or chronic dissection-related complications face high morbidity and mortality if not treated promptly. For most patients requiring intervention, thoracic endovascular aortic repair (TEVAR) is considered the gold standard. However, both early and late TEVAR-related complications make decision-making complex, even for experienced clinicians. In many cases, optimal medical management with longitudinal imaging surveillance may be preferred. In response to these challenges, several societal guidelines have recently been published to provide evidence-based or expert consensus “best practice” recommendations. Although these guidelines share many commonalities, they also highlight key unresolved clinical questions. For example, debates persist over the appropriate use of TEVAR for “uncomplicated” TBAD, defining “high-risk” criteria for uncomplicated presentations, and management of the false lumen, among other topics. Despite recent updates, a critical evaluation of the nuanced differences between these guidelines is lacking. Therefore, the purpose of this review is to compare current clinical practice guidelines, highlight their similarities and differences, and offer a comprehensive evaluation of the evidence surrounding management of TBAD. Moreover, this analysis will provide recommendations to address important knowledge gaps.

AB - The management of type B aortic dissection is one of the most challenging and debated topics in contemporary cardiovascular surgery practice. Patients with acute or chronic dissection-related complications face high morbidity and mortality if not treated promptly. For most patients requiring intervention, thoracic endovascular aortic repair (TEVAR) is considered the gold standard. However, both early and late TEVAR-related complications make decision-making complex, even for experienced clinicians. In many cases, optimal medical management with longitudinal imaging surveillance may be preferred. In response to these challenges, several societal guidelines have recently been published to provide evidence-based or expert consensus “best practice” recommendations. Although these guidelines share many commonalities, they also highlight key unresolved clinical questions. For example, debates persist over the appropriate use of TEVAR for “uncomplicated” TBAD, defining “high-risk” criteria for uncomplicated presentations, and management of the false lumen, among other topics. Despite recent updates, a critical evaluation of the nuanced differences between these guidelines is lacking. Therefore, the purpose of this review is to compare current clinical practice guidelines, highlight their similarities and differences, and offer a comprehensive evaluation of the evidence surrounding management of TBAD. Moreover, this analysis will provide recommendations to address important knowledge gaps.

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DO - 10.1016/j.avsg.2025.01.002

M3 - Review

C2 - 39855382

AN - SCOPUS:85217953287

SN - 0890-5096

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

ER -

Critical Review of Guidelines for Type B Aortic Dissection

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