"More or less": management of type A aortic dissections in the endovascular era

Abstract

The management of type A aortic dissection presents a major therapeutic challenge in modern surgical practice. Whilst the traditional dictum, to provide timely surgical intervention with the minimum treatment needed to repair the ascending aorta as well as the primary tear, may be a reasonable strategy in older patients, a tailored approach is desired for younger patients to manage the immediate life-threatening condition, as well as for the management of lifelong complications of the residual dissected aorta. Endovascular technology continues to advance, providing an adjunctive role to open cardiac repair presently to manage downstream aortic pathology, with the aim of striving towards a complete endovascular solution for type A aortic dissections.

Keywords: Aortic dissection; Cardiac surgery; Endovascular surgery; Hybrid surgery; Treatment paradigm; Vascular surgery.

Fig. 1

Completion of fenestrated aortic arch endograft with supra-aortic stenting following ascending aorta repair and innominate artery bypass for complex type A aortic dissection

Fig. 2

Intra-operative image of a type A aortic dissection repair with side branch anastomosed to the innominate artery