It seems that there is scarcity of data regarding their natural history, clinical course and management. Non-A non-B AAD can be defined as an entry intimal tear, located beyond the left subclavian artery (LSA), with the dissection extending retrogradely into the aortic arch (descending entry type), or as an entry tear located between the innominate and the LSA (arch entry type), with or without distal extension of the dissection. von Segesser et al were the first to introduce the term “non-A non-B” when referring to intima tears sparing the ascending aorta. However, by default, they both fail to distinguish and address dissections confined or involving the aortic arch. Since the second half of the previous century, the Stanford and DeBakey classifications are the primary systems, which have consistently determined the patients’ management. If not addressed, it has a significant propensity for developing into a fatal disorder due to rupture, myocardial infarction, cardiac tamponade, aortic valve insufficiency, or even end-organ malperfusion. Subsequently, a “new” false lumen is formed, allowing blood to enter the tunica media. In an AAD, an intimal tear compromises the medial layer’s structural integrity, separating the aortic wall layers. 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.Īs part of the cluster of the clinical entities related to acute aortic syndromes, acute aortic dissection (AAD) is a challenging and life-threatening cardiovascular emergency, with approximately 6 new cases per 100000 population per annum. 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. 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. Currently, the available treatment methods in the surgical armamentarium are conventional open, endovascular techniques and combined hybrid methods. 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. ![]() 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. Non-A non-B aortic dissection (AAD) is an infrequently documented condition, comprising of only a small proportion of all AADs.
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