Beyond Uncertainty: Establishing the Oda Strategy for the Treatment of Acute Aortic Dissection
Abstract
1. Introduction
- Safe—avoiding injuries to patients resulting from the care that is intended to benefit them.
- Effective—delivering scientifically grounded services to those likely to benefit, while refraining from providing services to those unlikely to benefit, thus addressing both underuse and overuse.
- Patient-centered—providing care that aligns with individual preferences, needs, and values and ensuring all clinical decisions are guided according to patient priorities.
- Timely—reducing wait times and harmful delays for patients and their caregivers.
- Efficient—minimizing waste, particularly in the use of equipment, supplies, ideas, and energy.
- Equitable—providing care of consistent quality regardless of sex, ethnicity, geographic location, or socio-economic status.
2. Evolution of Aortic Dissection Treatment: Lessons from the Past
2.1. OMT-Only Era: Before the Advent of Surgical Options
2.2. Universal OAR Approach: The DeBakey Era
2.3. Stanford Classification and Its Enduring Influence
2.4. Modernization of OAR: Technological Advances and New Challenges
2.5. Rise of Stent Grafts: TEVAR and FET
2.6. Clinical Acceptance of TEVAR for Complicated Type B Dissection
2.7. FET: Limitations, Complications, and Ethical Concerns
- 1.
- Can stent grafts prevent false lumen expansion in cases with false lumen expansion?
- 2.
- Are unnecessary stent grafts being used in cases with no false lumen expansion?
- 3.
- Is the frequency of complications from stent grafts acceptable?
2.8. Reassessing the INSTEAD-XL Trial: Insights into Preemptive TEVAR
2.9. When to Intervene: Challenges in Timing TEVAR
2.10. Advances in TEVAR Technology: The GORE CTAG System
3. Future Perspectives in Aortic Dissection Management
3.1. OAR in the Future
3.2. Next-Generation TEVAR: Opportunities and Limitations
3.3. Emerging Therapies in OMT: Pharmacologic and Cellular Innovations
4. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
CT | Computed tomography |
CTAG | Conformable thoracic aortic graft |
dSINE | Distal stent graft-induced new entry |
FET | Frozen elephant trunk |
FLE | False lumen expansion |
IRAD | International Registry of Aortic Dissection |
OAR | Open aortic repair |
OMT | Optimal medical treatment |
RCT | Randomized controlled trial |
RTAD | Retrograde type A aortic dissection |
TBE | Thoracic branch endoprosthesis |
TEVAR | Thoracic endovascular aortic repair |
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Oda, K.; Takahashi, M.; Taketomi, R.; Akanuma, R.; Hasegawa, T.; Katahira, S. Beyond Uncertainty: Establishing the Oda Strategy for the Treatment of Acute Aortic Dissection. J. Clin. Med. 2025, 14, 5509. https://doi.org/10.3390/jcm14155509
Oda K, Takahashi M, Taketomi R, Akanuma R, Hasegawa T, Katahira S. Beyond Uncertainty: Establishing the Oda Strategy for the Treatment of Acute Aortic Dissection. Journal of Clinical Medicine. 2025; 14(15):5509. https://doi.org/10.3390/jcm14155509
Chicago/Turabian StyleOda, Katsuhiko, Makoto Takahashi, Ryuichi Taketomi, Rina Akanuma, Takahiko Hasegawa, and Shintaro Katahira. 2025. "Beyond Uncertainty: Establishing the Oda Strategy for the Treatment of Acute Aortic Dissection" Journal of Clinical Medicine 14, no. 15: 5509. https://doi.org/10.3390/jcm14155509
APA StyleOda, K., Takahashi, M., Taketomi, R., Akanuma, R., Hasegawa, T., & Katahira, S. (2025). Beyond Uncertainty: Establishing the Oda Strategy for the Treatment of Acute Aortic Dissection. Journal of Clinical Medicine, 14(15), 5509. https://doi.org/10.3390/jcm14155509