Thoracic Endovascular Aortic Repair for Type B Aortic Dissections in Patients With Marfan Syndrome.

BACKGROUND

Marfan syndrome is associated with progressive aortic pathology, often necessitating complex surgical interventions. Thoracic endovascular aortic repair (TEVAR) has emerged as a palliative and adjunct therapy for managing type B aortic dissections, though its long-term durability in heritable thoracic aortic disease remains uncertain.

CASE SERIES: We report 7 patients with Marfan syndrome undergoing TEVAR for type B aortic dissections. TEVAR in these patients restored true lumen flow, stabilized the aorta, and facilitated staged or hybrid repair strategies. All procedures were guided by detailed imaging and intraoperative intravascular ultrasound. Early outcomes were favorable, with successful false lumen exclusion, restored visceral perfusion, and minimal perioperative complications. Some patients required subsequent open repair or redo TEVAR, reflecting limitations in long-term durability.

DISCUSSION: TEVAR is safe and effective in the early management of complex aortic dissections in Marfan syndrome, serving as a bridge or adjunct to definitive repair. Long-term durability and reintervention risk remain concerns.

TAKE-HOME MESSAGES: TEVAR can be safely applied in Marfan-associated type B dissections to stabilize the aorta, restore true lumen flow, and facilitate staged or hybrid repair strategies. Long-term durability of TEVAR in patients with Marfan syndrome is uncertain, with high rates of reintervention.