Anatomical Abnormalities of the Pelvic Venous System and their Implications for Endovascular Management of Pelvic Venous Reflux

Abstract

Background: To report a new classification for aortic dissections (AD), based on a modified Stanford classification, to consider the aortic arch as a separate entity and integrate patterns influencing treatment strategy notably malperfusion syndrome (MPS). The proposed classification was evaluated in a large population of ADs. Method(s): All patients with proven de novo acute AD who were admitted to our hospital from 2005 to 2017 were included in this study. All pre-therapy CT angiographies were reviewed and reclassified using the new classification based on three types and four subtypes: Type: A, dissection involving at least the ascending aorta; Type B, dissection involving exclusively the descending aorta; and type C, dissection involving the aortic arch with/without descending aorta. Subtype: 0; absence of MPS; 1, dynamic MPS; 2, static MPS; 3, static and dynamic MPS. Result(s): A total number of 228 consecutive patients were included in the study. According to the new classification, AD were distributed as 153 type A, 50 type B (38B0, 5B1, 6B2, 1B3) and 25 type C (18C0, 6C2, 1C3). The new type represented 11% of all ADs. MPS was present in 28% of type C. Treatment strategies in type C included endovascular interventions and surgery in 32% and 12%, respectively. Conclusion(s): The new classification is easy to use and feasible in a large group population. It should be helpful driving the decision making process and especially in integrating the latest development in trans-catheter therapies.