Manar Khashram
Acute aortic dissection is a rare but life-threatening condition caused by a tear in the aorta’s inner wall. It is classified into two types: Type A, which occurs near the heart and usually requires urgent surgery, and Type B, which occurs further down the aorta. Type B dissections can be either complicated or uncomplicated. While complicated cases often need immediate intervention, the best treatment for uncomplicated cases remains unclear. Current guidelines suggest starting medical therapy and possibly using a stent graft (TEVAR), but there is no strong evidence that this improves survival. Some studies hint at benefits, but more research is needed to confirm this.
The main goal of this trial is to find out whether early TEVAR improves five-year survival for patients with uncomplicated Type B aortic dissection compared to medical therapy alone. Secondary goals include measuring aortic-related deaths, hospital readmissions, and the need for further procedures.
Patients admitted with uncomplicated Type B dissection within 90 days of onset will be screened. After discussing the trial with patients and their families and obtaining consent, participants will be randomly assigned to either receive TEVAR plus medical therapy or medical therapy alone. The study will follow patients for five years, analyzing survival and other outcomes using standard statistical methods. The trial is designed to reflect real-world practice and allows crossover if necessary.
An aortic dissection is a sudden tear in the aorta that can be fatal if untreated. Some cases are complicated and need urgent surgery, while others are uncomplicated and managed differently across hospitals. There is no clear evidence on the best approach for uncomplicated cases. This trial will compare two strategies: medication alone versus medication plus a stent graft. The results will help determine the safest and most effective treatment, especially for Māori patients who are disproportionately affected by this condition.
Previous trials on uncomplicated dissections were done decades ago, before modern advances in diagnosis and treatment. Those studies showed only minor benefits from surgery, and survival rates were similar between groups. This new trial aims to provide up-to-date evidence on the safest and most effective treatment strategy. It will also improve awareness, streamline care, and include patient-reported outcomes to guide future treatment plans.
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