Christodoulou KC, Karangelis D, Efenti GM, Sdrevanos P, Browning JR, Konstantinou F, Georgakarakos E, Mitropoulos FA, Mikroulis D. Current knowledge and contemporary management of non-A non-B aortic dissections. World J Cardiol 2023; 15(5): 244-252 [PMID: 37274377 DOI: 10.4330/wjc.v15.i5.244]
Corresponding Author of This Article
Dimos Karangelis, MD, PhD, Assistant Professor, Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, 6th km. Alexandroupolis-Makris, Dragana, Alexandroupolis 68100, Greece. dimoskaragel@yahoo.gr
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. May 26, 2023; 15(5): 244-252 Published online May 26, 2023. doi: 10.4330/wjc.v15.i5.244
Current knowledge and contemporary management of non-A non-B aortic dissections
Konstantinos C Christodoulou, Dimos Karangelis, Gioultzan Memet Efenti, Panagiotis Sdrevanos, Jennifer R Browning, Fotis Konstantinou, Efstratios Georgakarakos, Fotios A Mitropoulos, Dimitrios Mikroulis
Konstantinos C Christodoulou, Dimos Karangelis, Jennifer R Browning, Fotis Konstantinou, Dimitrios Mikroulis, Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
Gioultzan Memet Efenti, Department of Surgery, Didimotichon General Hospital, Didimotichon 68300, Greece
Efstratios Georgakarakos, Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis 68100, Greece
Fotios A Mitropoulos, Department of Cardiac Surgery, Mitera Hospital, Athens 15123, Greece
Author contributions: Christodoulou KC wrote the manuscript; Karangelis D contributed to manuscript review and supervised the entire project; Efenti GM, Sdrevanos P, and Georgakarakos E contributed with bibliographic research and proofread the manuscript; Browning JR was responsible for the English language editing of the manuscript; Konstantinou F provided the accompanying figures; Mitropoulos FA and Mikroulis D designed the outline and coordinated the writing of the paper; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimos Karangelis, MD, PhD, Assistant Professor, Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, 6th km. Alexandroupolis-Makris, Dragana, Alexandroupolis 68100, Greece. dimoskaragel@yahoo.gr
Received: February 11, 2023 Peer-review started: February 11, 2023 First decision: March 28, 2023 Revised: April 10, 2023 Accepted: April 25, 2023 Article in press: April 25, 2023 Published online: May 26, 2023 Processing time: 96 Days and 20.7 Hours
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.
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.
