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Chang et al. Vessel Plus 2020;4:20 Vessel Plus
DOI: 10.20517/2574-1209.2020.10

Editorial Open Access

Endovascular treatment for type A aortic dissection
- What are our critical concerns?

Ting Wei Chang , Ting Ting Yang , Hong Jie Jhou , Liang Ying Ke , Ying Fu Chen 5,6,7
1,4
3
1,2
1
1 School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
2 Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
3 School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
4 Division of General Practice, Department of Medical Education, Changhua Christian Hospital, Changhua 500, Taiwan.
5 Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical
University, Kaohsiung 807, Taiwan.
6 Division of Cardiovascular Surgery, Tainan Sin-Lau Christian Hospital, Tainan 701, Taiwan.
7 Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
Correspondence to: Dr. Ying Fu Chen, Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University
Hospital, Kaohsiung Medical University, No. 100, Tzyou First Road, Kaohsiung 807, Taiwan. E-mail: yfchen@kmu.edu.tw

How to cite this article: Chang TW, Yang TT, Jhou HJ, Ke LY, Chen YF. Endovascular treatment for type A aortic dissection - What
are our critical concerns? Vessel Plus 2020;4:20. http://dx.doi.org/10.20517/2574-1209.2020.10

Received: 28 Mar 2020 First Decision: 20 Apr 2020 Revised: 23 May 2020 Accepted: 29 May 2020 Published: 12 Jul 2020
Academic Editor: Cristiano Spadaccio Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

INTRODUCTION
Endovascular graft intervention has brought new therapeutic concepts to conventional cardiovascular
surgery. In 1991, an Argentinean team first described aortic endograft placement in the repair of abdominal
aortic aneurysms, paving the way for new interventions in the management of aortic disease. Following
[1]
this, endovascular aneurysm repair (EVAR) and thoracic EVAR (TEVAR) were developed in succession .
[2]
In 1999, Dake et al. reported promising results (100% technical success and 16% 30-day mortality) in the
endovascular management of patients with acute aortic dissection, including 4 patients with retrograde
acute type A dissections and 15 patients with acute type B dissections.

With the advantages of minimally invasive procedures, TEVAR plays an important role, especially in older
patients with multiple co-morbidities suffering from acute type A aortic dissection (ATAAD). Complete
coverage of the entry tear is essential in the endovascular intervention of ATAAD as it depressurizes the
false lumen, redirecting blood flow into the true lumen, resulting in thrombosis of the false lumen, thus
allowing for aortic remodeling.

[3]
Nienaber et al. reported an international multi-centre experience of 12 type A aortic dissection (TAAD)
patients (6 cases of acute and subacute or chronic each) with a mean age of 81 ± 7 years and a Euro SCORE

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