Multicentre Retrospective Cohort Study on Current Practices in Treatment of Patients Presenting with Non-A Non-B Aortic Dissection - Objectives, Methods, Results and Conclusions

Sep 30, 2026

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Multicentre retrospective cohort research evaluates current treatment strategies for Non-A Non-B aortic dissections across four European aortic centres. The study analyzes anatomical, clinical, and therapeutic variables collected over the last decade, aiming to determine factors linked to intervention requirement and increased mortality, including comparisons between surgical and medical-only pathways. Thirty-eight patients are included, with early surgery often driven by end-organ ischemia, impending rupture, or dissection extension, and higher in-hospital mortality observed after medical treatment.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Objectives

Methods

Results

Conclusions

Introduction

Article Multicentre Retrospective Cohort Study on Current Practices in Treatment of Patients Presenting with Non-A Non-B Aortic Dissection and Factors Predicting the Need for Intervention and Mortality Ottavia Borghese 1,2, *, Gabriel Lopez-Pena 3, Athanasios Saratzis 3,4, Tryfon Vainas 3, Alice Lopes 5, Blandine Maurel 6 and Tara Mastracci 1,7 Academic Editor: Giovanni Coppi Received: 2 November 2025 Revised: 7 December 2025 Accepted: 17 December 2025 Published: 27 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Cardiothoracic Surgery, St. Bartholomew’s Hospital, London EC1A 7BS, UK 2 Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy 3 Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK 4 Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE1 7RH, UK 5 Heart and Vessels Division, Hospital de Santa Maria (ULS), 1649-035 Lisbon, Portugal 6 Service de Chirurgie Cardio-Vasculaire, L’institut du Thorax, CHU Nantes, Université de Nantes, 44307 Nantes, France 7 Department of Surgery and Interventional Sciences, University College London, London WC1E 6BT, UK * Correspondence: [ottaviaborghese@gmail.com](ottaviaborghese@gmail.com) Abstract Objectives: Non-A Non-B (NANB) aortic dissections (ADs) are uncommon. Because of their rarity, their therapeutic pathway is not yet standardized, and anatomic or goal-directed treatments are not reported in current practices. We reviewed the treatment strategies of NANB AD across Europe, aiming to identify factors associated with increased mortality and the need for intervention, outlining optimal management pathways for future care. Methods: This multicentre cohort study was carried out in four European aortic centres, retrospectively including patients affected by NANB AD over the last 10 years. Patients’anatomical clinical and treatment data were collected with the aim of investigating the factors associated with their need for intervention and increased mortality, comparing the characteristics of those requiring surgery with those who responded to medical treatment alone. Results: Thirty-eight NANB patients (26, 68.4% men; mean age 60.6 ± 12.87) were included. The primary entry tear was identified in Ishimaru zone 1 or 2 in most cases (24, 63.2%) and the dissection extended distally to the ilio-femoral arteries in half of the patients (21, 55.3%) . Surgical repair was indicated in 21 (55.3%) cases within 90 days of acute onset for end-organ ischemia, impending aortic rupture, or retrograde extension of the dissection (including 11 emergent/urgent operations), with most patients requiring surgery within 15 days of acute onset (17, 44.7%) . The mean aortic diameter among patients requiring surgery was significantly higher in both zone 1 (7 37 IQR 3 versus 34 IQR 7, p = 0.043) and 2 (36 IQR 6 versus 32.5 IQR 7, p = 0.044) when compared with patients who underwent medical treatment alone. An increased in-hospital mortality rate was noted among patients with indication for surgery after medical treatment (0% versus 30.8%, p = 0.023) . Conclusions: This cohort provides an additional description of clinical aspects and current practices in the treatment of NANB in Europe. Most patients of this series had an indication for surgery within two weeks of acute onset, demonstrating a frequently complicated course; moreover, this raises questions surrounding the most appropriate timing for interventional management. Although a diameter threshold was not identified, the baseline enlarged aortic diameter in zones 1 and 2 seemed to be associated with a need for early intervention. Further study is needed to fully refine the indicatio

FAQs

Why is treatment for Non-A Non-B aortic dissection not standardized?

Non-A Non-B aortic dissections are uncommon, so therapeutic pathways are not yet standardized and current practices do not report consistent anatomic or goal-directed approaches.

What patient factors were assessed to predict the need for intervention and mortality?

The study collected anatomical, clinical, and treatment data to identify factors associated with intervention needs and increased mortality, comparing patients requiring surgery with those managed medically.

What did the study report about timing and indications for surgery?

Surgical repair was indicated for a majority of patients within 90 days of acute onset, most frequently within 15 days, driven by end-organ ischemia, impending rupture, or retrograde dissection extension.

Sep 30, 2026

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