ACute Uncomplicated Type b Aortic Dissection: Endovascular Repair vs. Best Medical Therapy

Eligibility Criteria

• * Aged ≥18 years, regardless of race or ethnicity;
• * Diagnosed with uncomplicated ABAD, i.e., a primary entry tear distal to left subclavian artery with no evidence of malperfusion, end-organ ischemia, rupture, or intractable pain, and onset of symptoms is ≤30 days prior to enrollment;
• * Patient has been stabilized after the acute event with control of pain and blood pressure using ≤3 intravenous antihypertensive medications;
• * Adequate imaging, e.g., CT with contrast (chest + abdomen+ pelvis) is available prior to enrollment; and
• * Indicates willingness to comply with the study protocol and is able to provide a written informed consent;
• * Meets criteria for inclusion in the National Death Index and Social Security Death Master File.
• * Diagnosed with Type A aortic dissection;
• * Evidence of complicated ABAD;
• * Chronic Type B aortic dissection (\>6 weeks from onset of symptoms);
• * Unable to be randomized and undergo treatment according to protocol within 30 days of symptom onset;
• * Diagnosed with traumatic dissection or penetrating ulcer;
• * Anatomy is not suitable for TEVAR;
• * Previous descending thoracic or abdominal aortic surgery (open or endovascular);
• * Unsuitable access sites, including infection at access sites;
• * Associated aortic aneurysm (descending aortic diameter ≥5.0 cm);
• * Life expectancy \<2 years;
• * Unable or unlikely to comply with BMT;
• * Unable or refuse to comply with follow-up;
• * Intend to participate in another trial within 3 months of enrollment;
• * Pregnant or breast-feeding;
• * Vasculitis or known genetic connective tissue disorder (Marfan's syndrome or Ehlers-Danlos syndrome)
• * Active systemic infection;
• * Chronic kidney disease stage 3-5 (estimated glomerular filtration rate \<60 mL/min/1.73m2);
• * Cerebral vascular accident within past 3 months; or
• * Clinically significant gastrointestinal bleeding, major surgery, myocardial infarction, or untreated coagulopathy within past 6 weeks.