Discussion
Due to the increasing incidence rate and high mortality of TBAD in
pregnancy, the effective rescue procedures and surgical methods of this
disease deserves more concern. To date,there is no specific guideline,
and its treatment experiences are mainly based on case series or a
synthesis of current published opinions10. While TEVAR
has been widely used in complicated TBAD in unpregnant patients and is
increasingly being utilized in pregnant patients for aortic repair, the
literature lacks consensus regarding whether to conducting TEVAR first
or cesarean section. The available literature exhibits divergent
treatment options across different medical centers, with some authors
advocating for aortic repair surgery first and others approving the
priority of caesarean section to avoid the influences of radiation
caused by TEVAR on the neonates11-14.Due to the
different levels of treatment and the severity of the patient’s
condition, it is difficult to evaluate the treatment strategies. Here,
we reported clinical data from five patients with complicated TBAD in
late second and third trimester. By exploring the optimal strategy for
complicated TBD in late pregnancy in clinical practice, we found that
TEVAR is safe and feasible. In addition, the strategy of TEVAR first can
avoid rupture of aortic dissection caused by delivery, thus improving
both maternal and fetal outcomes.