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Closing the gap between type A and type B aortic dissections

Carino, Davide; Castellà, Manuel; Quintana, Eduard

doi: 10.1097/HCO.0000000000000666

Purpose of review Given its rarity little is known about natural history, surgical indications, and results of acute non-A non-B dissections. With this review, we aim to review the current knowledge of this subject.

Recent findings non-A non-B aortic dissections should be differentiated from type B aortic dissections. A strikingly high proportion of these patients have a complicate course requiring treatment and the mortality of patients treated with medical therapy is substantially higher compared to type B dissections. Surgical and endovascular treatment can be accomplished safety, with very good results in terms of mortality and morbidity also in the acute setting. Several treatments options are available including endovascular repair with thoracic endovascular aortic repair (TEVAR) associated with Chimney grafts or carotid to subclavian by pass, open arch replacement mainly by means of the frozen elephant trunk technique and hybrid arch repair with debranching of the supra-aortic vessel and zone 0 TEVAR.

Summary considering the high rate of complication, the high mortality of patients managed medically and the safety of surgical and endovascular repair, early invasive treatment of non-A non-B dissections may be further considered. The treatment should be tailored to the morphology of the dissected aorta with TEVAR reserved to more distal lesions and open arch replacement with the FET technique for more proximal lesions.

Department of Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain

Correspondence to Davide Carino, MD, Department of Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain. . Tel: +39 349 7207720; e-mail:

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