Type B dissection of the aorta will be the main topic of controversy at this year’s Charing Cross Symposium. Predictions of clinical success after thoracic endovascular aortic repair (TEVAR), factors that predict success after TEVAR for chronic type B dissection, the latest evidence for embolisation of false lumen and spinal cord protection are some of the topics that will be discussed in the CX Thoracic Aortic Controversies Day (Thursday 30 April).    

Last year, the majority of delegates who attended a debate titled “For uncomplicated type B dissections, early intervention is indicated” voted against the motion. This year, the debate in this area will assess whether the long-term results following intervention for sub-acute uncomplicated type B dissection warrant intervention.

The Thoracic Aortic Day will also include discussions on the incidence of stroke during aortic arch interventions, treatment options for ascending and arch of the aorta including TEVAR, branched stent grafts for complex arch lesions, open surgery and the use of robotic systems.  

Furthermore, amongst the descending thoracic aortic, thoracoabdominal and juxtarenal aortic controversies, the question of threshold diameter for intervention in the thoracic aorta will be raised. Roger Greenhalgh (Imperial College, London, UK), chairman of the CX Programme Organising Board, says: “Evidence for the precise diameter to intervene is extremely sparse and this will be brought out in the session”.

Interview with Andrew Holden, member of the CX Programme Organising Board

Andrew Holden (Auckland City Hospital, Auckland, New Zealand), member of the CX Programme Organising Board and chairman of the session “Controversies in chronic type B dissection of the aorta” speaks on the subject.  

Why is the management of chronic type B dissections controversial?

Currently, this is one of the most important sessions at CX and hopefully some consensus will emerge. There is no doubt that treatment of acute complicated type B aortic dissection is widely accepted. What is less clear is whether uncomplicated type B dissection should undergo endovascular treatment and if so when (acute, sub-acute or chronic). In chronic type B dissection, the biggest challenge is to successfully exclude the aneurysmal component (preventing retrograde false lumen perfusion) and maintain branch artery patency.

What are the factors that must be considered when treating chronic type B dissections?

The common thread when treating chronic type B dissection is to exclude the primary (or inflow) intimal tear. It is then unclear how much aorta needs to be covered and how retrograde perfusion of the false lumen can be avoided. In the dissected and aneurysmal abdominal aorta, the challenge is to exclude the false lumen but maintain branch artery patency.

What challenges in TEVAR have to be overcome in order to avoid complications?

Feared complications in TEVAR include retrograde dissection and spinal ischaemia. A number of strategies have been developed and will be discussed at the CX Thoracic Aortic Controversies Day.

The CX Thoracic Aortic Controversies Day will take place at the Charing Cross Symposium on Thursday 30 April – Main Auditorium, Olympia Grand, London, UK

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