Endovascular repair of type Adissection: The next frontier

Type A aortic dissection (TAAD) represents a true surgical emergency and despite refinements in techniques of surgical repair over the last twenty years, is still associated with significant morbidity and mortality. Endovascular stent grafting in the descending thoracic and abdominal aorta have revolutionized the management of aneurysms and dissections in those vascular beds and are generally associated with less morbidity and mortality compared to open surgical repair. Endovascular stent grafting of the aortic arch is currently undergoing clinical trials with several different manufacturers devices. Endovascular management of TAADrepresents the next frontier in the endovascular revolution of the aorta. Specific anatomic challenges, however, make stent grafting for TAAD much more formidable than in the other vascular beds. The first multicenter clinical trial for endovascular management of TAAD is currently enrolling patients at a limited number of sites in the USA. This review highlights some of the challenges associated with endovascular repair of TAAD, outlines the current status of ongoing clinical trials, and reviews the limited worldwide experience with endovascular repair of TAAD.