Non-A non-B aortic dissection: just for cardiac surgeons? A systematic literature review on surgical and endovascular treatment

INTRODUCTION: Non-A non-B dissections are fairly rare occurrences, accounting for just a small percentage of total aortic dissections. For years, treatment has been non-consensual being mostly confined to the realm of cardiac surgery. In recent times, due to the development of endovascular techniques, a procedural shift has occurred favoring less invasive vascular surgery thus precepting the need for a multidisciplinary approach and the concept of an aortic team in treating non-A non-B dissections. The aim of our study is to report on the state-of-the-art treatment of non-A non-B dissections and to determine, through a systematic review, how often an aortic team is employed in clinical practice. EVIDENCE ACQUISITION: A review conducted of all available PubMed/MEDLINE and Scopus databases in accordance with PRISMA statement guidelines, analyzing all studies published between 2000 and 2023. Combined keywords referring to non-A non-B dissections and their management, and investigation of current employment of endovascular techniques in treating these dissections. Our literature search initially covered a total of 260 articles concerning surgical, endovascular and hybrid treatment. Out of these, 21 articles were selected for screening, excluding those with no mention of non-A non-B dissection and “aortic team.” EVIDENCE SYNTHESIS: Non-A non-B aortic dissections remain a challenging pathology with several treatment options, including endovascular, which is increasingly being employed, and can therefore be considered a valid treatment choice in aortic dissection management. CONCLUSIONS: While guidelines mention the importance of an aortic team in treatment, no clear evidence of a multidisciplinary approach for treating non-A non-B dissection could be found in current literature.