This review shows that aortic dissection treatment is no longer a simple “Type A surgery, Type B medicine” paradigm: outcomes now depend on timing, anatomy, malperfusion, remodeling strategy, and lifelong surveillance. The full paper is worth reading because it maps where TEVAR, open surgery, hybrid repair, medical stabilization, and emerging pharmacological strategies truly change survival—and where uncertainty still demands careful patient selection.
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Abstract: The aim of this review is to evaluate contemporary treatment strategies for aortic dissection, including surgical repair, endovascular intervention, acute medical stabilization, and long-term pharmacological risk modification, and their impact on patient survival and aortic remodeling. The review utilises 3527 original studies with 4267877 total participants (topic deduplicated ΣN). The mapped evidence indicates that early invasive intervention is the dominant signal across aortic dissection care, with surgical repair for acute Type A dissection associated with a median 30-day mortality of 11.6%. For Type B dissection, thoracic endovascular aortic repair showed favorable mid- to long-term outcomes across distinct settings, including 91.9% 5-year survival versus 82.2% with best medical treatment in selected acute uncomplicated TBAD cohorts, and 73% 5-year survival after emergency TEVAR for complicated TBAD with rupture or malperfusion. Recurrent therapeutic signals support thoracic endovascular aortic repair as first-line management for complicated Type B dissection, subacute rather than hyperacute timing for uncomplicated cases, and selective use of frozen elephant trunk, hybrid, and branched approaches for arch-involving disease. Adjunctive themes including antegrade cerebral perfusion, valve-sparing root repair, early renal replacement therapy, and avoidance of fluoroquinolones and inappropriate antithrombotics in misdiagnosed cases consistently emerged as supportive of improved organ-specific outcomes. The evidence map also highlights persistent uncertainty around uncomplicated Type B dissection thresholds, durability of endovascular repair in heritable thoracic aortic disease, and optimal sequencing of malperfusion management, while psychosocial sequelae such as post-traumatic stress disorder affecting roughly 21% to 23% of survivors remain underaddressed in standard pathways. Practically, these findings support centralized, multidisciplinary, imaging-guided care pathways that integrate rapid diagnosis, anatomy-tailored intervention, lifelong surveillance, and long-term antihypertensive therapy. Future research should prioritize randomized comparisons of preemptive endovascular repair versus optimal medical therapy in high-risk uncomplicated Type B dissection, alongside development of endografts and pharmacologic strategies tailored to fragile or heritable aortic tissue.
Keywords: Aortic dissection; Thoracic endovascular aortic repair; Type A aortic dissection; Type B aortic dissection; Surgical treatment; Frozen elephant trunk; Medical management; Endovascular stent grafts; Aortic remodeling; False lumen thrombosis
Review Stats
Final search date and database lock: 2026-04-28 11:20:44 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 7920
Downloaded Abstracts/Papers: 7920
Included original and non-original Abstracts/Papers (all): 3979
Included original Abstracts/Papers (Vote counting by direction of effect): 3527
Reference Index (links used in paper): 207
Total participants (topic deduplicated ΣN): 4267877
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