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DOI: 10.1055/s-0037-1598836
Acute Non-A Non-B Aortic Dissection: Definition, Treatment and Outcome
Publication History
Publication Date:
03 February 2017 (online)
Objectives: Treatment options and outcome in patients with acute Type A or B dissection are widely reported. Little is known about Non-A Non-B dissection involving aortic arch, but not the ascending aorta. We hypothesized that acute Non-A Non-B aortic dissection requires early aortic repair to avoid organ malperfusion, aortic rupture and rapid aortic growth.
Methods: Dissection extension and entry localization were analyzed in patients with acute aortic dissection admitted between January 2001 and June 2016 at one tertiary center. Non-A Non-B dissection was classified into Type 1 with entry distal to the left subclavian artery and dissection extending into the aortic arch and Type 2 with entry between the innominate and left subclavian arteries. Clinical presentation, treatment and outcome were compared between both groups.
Results: Among 396 acute aortic dissection patients, 43 (median age 60 ± 12 years, 81% males) had Non-A Non-B dissection (Type 1 n = 21, Type 2 n = 22). Common origin of the innominate and left common carotid artery, bicarotid trunk and left vertebral artery origin from the aortic arch were observed in 28%, 2% and 16% patients, respectively. Vast majority of aortic segments was not dilated in all patients. Cardiovascular risk profile did not differ between both groups. Emergency open or endovascular aortic repair were necessary due to malperfusion or aortic rupture in 29% Type 1 and 36% Type 2 (in-hospital mortality was ⅙ and ⅜, respectively). Aortic repair within 2 weeks due to new organ malperfusion, rapid aortic growth, aortic rupture or persisting pain was performed in 43% Type 1 and 36% Type 2 patients (0% in-hospital mortality). All other except for 1 diagnosed in 2014, required aortic repair for aneurysm at follow-up.
Conclusion: Acute Non-A Non-B aortic dissection frequently requires emergency aortic repair due to organ malperfusion or aortic rupture. Majority of both Type 1 and 2 Non-A Non-B dissection patients undergo aortic repair within 2 weeks after dissection onset.