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.