Non-A non-B acute aortic dissection with entry tear in the aortic arch

Kosiorowska, Monika; Berezowski, Mikołaj; Widenka, Kazimierz; Kreibich, Maximilian; Beyersdorf, Friedhelm; Czerny, Martin; Rylski, Bartosz

doi:10.1093/icvts/ivab375

Cited by 17 publications

(4 citation statements)

References 14 publications

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“…This approach provides an ideal landing zone for secondary endovascular or open surgical interventions. TEVAR in non-A non-B dissection patients presenting the entry in the aortic arch is unsuitable due to the exceptionally high risk of retrograde aortic dissection of type A [6,[11][12][13].…”

Section: Acute Aortic Dissectionmentioning

confidence: 99%

Thoracic endovascular aortic repair: Current evidence and challenges

Juraszek¹,

Czerny²,

Rylski³

2022

Kardiol Pol

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In 1987 Nikolay Volodos performed the world's first endovascular treatment of aortic aneurysms. Endovascular technology has progressed significantly since then. There are now many thoracic endovascular aortic repair (TEVAR) systems commercially available. By applying them, we can treat many pathologies: aneurysms, dissections, aortic ruptures, and penetrating aortic ulcers. However, TEVAR technology still has its limitations, namely the risk of a retrograde type A dissection, the issue of precise landing in the distal landing zone, and the risk of air embolism and paraplegia. Furthermore, there are no appropriate stent grafts widely available to treat acute dissections. Those currently used are designed for aneurysms, not for dissections. As a result, there are several challenges facing the future TEVAR surgical community, such as the need to develop new and more precise systems with retrograde deployment for the distal landing zone, as well as to introduce flexible stent grafts to treat dissections. The endo-Bentall is being developed as an alternative treatment method for acute type-A aortic dissection.

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Section: Acute Aortic Dissectionmentioning

confidence: 99%

Thoracic endovascular aortic repair: Current evidence and challenges

Juraszek¹,

Czerny²,

Rylski³

2022

Kardiol Pol

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“…3 Treating this condition requires surgeons to undertake one of the most challenging interventions. 4,5 Previously, a study from the International Registry of Acute AD (IRAD) showed that retrograde arch extension of distal dissection did not influence management strategy or mortality. 6 They suggested that non-A non-B AD could be managed as Stanford type B aortic dissection (TBAD).…”

Section: Introductionmentioning

confidence: 99%

“…3 Treating this condition requires surgeons to undertake one of the most challenging interventions. 4,5…”

Section: Introductionmentioning

confidence: 99%

Differences in In-Hospital and Follow-Up Outcomes Between Non-A Non-B Aortic Dissection and Type B Aortic Dissection Treated by Endovascular Based Treatment

Li,

Deng

et al. 2024

Vasc Endovascular Surg

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Objectives Non-A non-B aortic dissection (AD) is a rare and life-threatening medical emergency, and it has been controversial whether it should be managed as type B aortic dissection (TBAD). The study aims to compare in-hospital and follow-up outcomes between patients with non-A non-B AD and those with TBAD treated by endovascular based treatment (EBT). Methods From January 2017 to December 2021, 96 consecutive patients with non-A non-B AD met the inclusion criteria and underwent EBT. Patients with TBAD were matched to patients with non-A non-B AD at a 1:1 ratio using propensity score matching analysis to correct for baseline confounding factors. The primary endpoint was all-cause mortality. Aortic-related events were defined as dissection-related death, aortic rupture, retrograde type A aortic dissection, reintervention, and type Ia endoleak. Results Patients with non-A non-B AD required more TEVAR-related adjunctive procedures compared to TBAD patients during EBT and they required a longer ICU length of stay (36.0 vs 24.0 hours, P < .05) as well as a longer hospitalization (8.0 vs 7.0 days, P < .05) after EBT. There was no statistical difference in overall survival after EBT for patients with TBAD and non-A non-B AD. However, compared to patients with TBAD, non-A non-B AD patients had a higher rate of reintervention and experienced more aortic-related late events during follow-up. Conclusion Patients with non-A non-B acute AD who are treated with EBT do not have higher in-hospital or follow-up mortality rates compared to patients with type B AD. However, there is an increased risk of reintervention and aortic-related late events after the intervention during follow-up.

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“…Aortic arch dissection involving an entry tear in the aortic arch is a complex condition with a higher mortality rate than other types of aortic dissection [4]. Therefore, it is essential that these patients are treated in high-volume cardiac surgery centers with an aortic team on board.…”

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confidence: 99%