Time is aorta in uncomplicated type B aortic dissection

Background: While cardiovascular control optimization through best medical therapy (BMT) 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 favourable aortic remodelling and improve long-term outcomes. However, the optimal timing of TEVAR in uTBAD remains debatable. This narrative review aims to evaluate the safety, efficacy, and outcomes of TEVAR at different time points in 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 uncomplicated type B aortic dissection. 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 remodelling, but it is burdened by relatively 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 mortality, complications, and aortic remodelling outcomes. 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 remodelling for the subacute phase. Conclusions: The consistent findings across the studies indicate that the subacute phase offers the best combination of reduced procedural risks and favourable long-term outcomes. However, ,more substantial evidence is needed to refine timing strategies.