Non-A non-B aortic dissection: a systematic review and meta-analysis

Non‐A non‐B aortic dissection: A literature review

“…However, neither of these classifications address dissections involving the aortic arch alone or dissections comprising of the aortic arch and the descending aorta. When the dissection is limited to the aortic arch or can be described as a retrograde dissection arising from the descending aorta that extends into the arch and stops before the ascending aorta; these dissections are then termed as non‐A non‐B aortic dissections 4,11 . The Contemporary classifications such as the TEM (Type, Entry and Malperfusion) aortic dissection classification include non‐A non‐B dissections 12 …”

“…Carino et al in their systematic review demonstrated in their analysis that 88% of non‐A non‐B aortic dissection patients had a complicated disease course and that 29% of these patients had signs of malperfusion; defined as a loss of blood supply to vital organs resulting in end‐organ ischemia 11,21 . This percentage formed a considerably larger proportion than observed in type B aortic dissections 22–24 …”

“…Various surgical approaches exist, however, endovascular treatment has been shown in a recent systematic review and meta‐analysis to be the most widely used technique 11,25 . In their study, TEVAR made up a significant percentage of surgical treatments for Non‐A non‐B dissections; TEVAR with extrathoracic surgical transposition of the supra aortic branches was adopted in 18% of surgeries and TEVAR with chimney stent graft in 36% of cases 11 . A growing proportion of studies also list TEVAR as the treatment of choice for acute complicated and many chronic type B and Non‐A non‐B aortic dissections 25,26 .…”

“…When the entry tear occurs in the proximal aortic arch more invasive solutions can be necessary which include hybrid repair that involves rerouting of the arch branches and Zone 0 TEVAR or arch replacement. A recent systematic review and meta‐analysis by Carino et al 11 demonstrated that these hybrid techniques have been utilized for non‐A non‐B dissections in 21% of total surgical cases. Zone 0 TEVAR use in hybrid procedures for acute dissection has been shown to be considered dangerous with a significantly higher risk of retrograde dissection in comparison to a more distal landing zone 42–44 …”

“…This procedure involves ascending aorta and arch replacement in combination with antegrade stent graft implantation in the descending thoracic aorta while using a single hybrid prosthesis 26 . A recent systematic review and meta‐analysis by Carino et al 11 found that 7% of patients were treated with this technique and that FET may also be an important option in cases of malperfusion syndrome as it can potentially open the compressed true lumen and cover any additional entry tears that could be positioned in the proximal descending aorta so that pressurization the false lumen is maintained 11,26,49 . FET is also recognized in the literature to promote favorable remodeling in the distal aorta 50,51 .…”