Time is Aorta in Uncomplicated Type B Aortic Dissection

Background: Although cardiovascular control optimization through best medical therapy remains the gold standard of treatment for uncomplicated type B aortic dissection (uTBAD) according to international guidelines, thoracic endovascular aortic repair (TEVAR) has increasingly emerged as a viable and appealing treatment option due to its potential to induce favorable aortic remodeling and improve long-term outcomes. However, the optimal timing of TEVAR in uTBAD remains a subject of debate. This narrative review aims at evaluating safety, efficacy, and outcomes of TEVAR at different time points of the disease history. Methods: We conducted a comprehensive literature review across multiple electronic databases, including PubMed and Scopus, to synthesize research evidence on the timing of TEVAR in uTBAD. Results: Hyperacute-phase TEVAR (<24 hours) is associated with prohibitive periprocedural risks and is thus discouraged. Acute-phase TEVAR (1-14 days) may provide benefits in aortic remodeling but it is burdened by rather elevated rates of early complications and reinterventions. The subacute phase (14-90 days) is consistently identified as the optimal therapeutic window, balancing procedural safety and efficacy, with studies reporting superior outcomes in terms of mortality, complications, and aortic remodeling. Chronic-phase TEVAR (>90 days), although sometimes necessary in cases of disease progression, is associated with poorer outcomes, including higher rates of reintervention, complications, and limited aortic remodeling with respect to the subacute phase. Conclusion: The consistent findings across the studies analyzed indicate that the subacute phase offers the best combination of reduced procedural risks and favorable long-term outcomes. However, stronger evidence is needed to refine timing strategies.