1.0 Introduction
Non-A non-B aortic dissections are a rare occurrence and treating this
life-threatening medical emergency often requires surgeons to undertake
some one of the most challenging surgical or endovascular cases in
medicine. In general, acute aortic dissections are a serious condition
characterised by a tear in the aorta’s intima allowing blood to enter
the medial layer of the aorta therefore splitting the aortic wall into
two layers, hindering blood flow and causing end-organ malperfusion
(Hiratzka et al. , 2010; Czerny et al. , 2015). In 1994 von
Segesser proposed the term the non-A non-B dissection for dissections in
which an intima tear is localised beyond the ascending aorta (von
Segesser et al. , 1994). In these forms, the dissection is limited
to the aortic arch or can be described as a retrograde dissection
arising from the descending aorta that extends into the arch and stops
before the ascending aorta (Urbanski and Wagner, 2016).
In untreated acute type A aortic dissection, the rate of mortality
within in the first 48 hours is greater than 50% and emergency open
surgery is generally indicated (Gallo et al. , 2005; Erbelet al. , 2014). However, the progression of acute type B
dissection is often uncomplicated and the generally accepted first line
treatment for this consists of medical therapy (Erbel et al. ,
2014; Hiratzka et al. , 2010; Riambau et al. , 2017). In
complicated acute type B dissection however thoracic endovascular aortic
repair (TEVAR) is the established treatment (Riambau et al. ,
2017; Erbel et al. , 2014). Non-A non-B dissections exist in
between these two entities and represents only a fraction of the
established literature on aortic dissections with evidence for their
optimum treatment and management thin.