Current knowledge and contemporary management of non-A non-B aortic dissections

Abstract

Non-A non-B aortic dissection (AAD) is an infrequently documented condition, comprising of only a small proportion of all AADs. The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD, have led to an ongoing controversy around the topic. It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections, frequently leading to serious complications and thus mandating early intervention. Currently, the available treatment methods in the surgical armamentarium are conventional open, endovascular techniques and combined hybrid methods. The optimum approach is tailored in every individual case and may be determined by the dissection’s location, extent, the aortic diameter, the associated complications and the patient’s status. The management of non-A non-B dissections still remains challenging and a unanimous consensus defining the gold standard treatment has yet to be reached. In an attempt to provide further insight into this perplexing entity, we performed a minireview of the literature, aiming to elucidate the epidemiology, clinical course and the optimal treatment modality.

Keywords: Aortic dissection; Aortic disease; Aortic surgery; Thoracic aorta disease; Aortic arch dissection

Core Tip: The available treatment options in the surgical armamentarium are conventional open surgery with standard aortic arch replacement or frozen elephant trunk (FET), interventional therapies such as the thoracic endovascular aortic repair (TEVAR) and hybrid techniques combining TEVAR with debranching of the supra-aortic vessels. In the case of a favorable arch anatomy, TEVAR is the preferable treatment option. Alternatively, when the entry tear is located in the proximal segment of the aortic arch, a hybrid arch repair, aortic arch replacement or even FET should be given thorough consideration.