Validity of current surgical strategies for aneurysmal progression in post-subacute Stanford type B aortic dissection: a propensity score–matched comparative analysis

Objective The use of preemptive thoracic endovascular aortic repair (TEVAR) has been expanding, especially in cases where aortic enlargement is an indication for surgical intervention. Current guidelines recommend treatment for chronic type B aortic dissection (TBAD) when aortic diameter increases by ≥5 mm over a 6-month period. However, the optimal window for preemptive TEVAR is the subacute phase (up to 3 months), creating a dilemma where intervention may be delayed beyond this window. This study investigates the short- and long-term outcomes of aggressive treatment for rapidly enlarging aneurysms. Subjects and methods Between July 2004 and August 2024, 432 patients with acute Stanford type B aortic dissection were treated at two centers. Of these, 324 patients who completed acute best medical therapy (BMT) were included. Patients with rapid enlargement of aortic aneurysms who did not meet absolute surgical indications (aneurysm diameter