Reply to Karangelis and Tagarakis

We are pleased to respond to the letter by Karangelis and Tagarakis [1] commenting on our systematic review and meta-analysis [2] on non-A non-B aortic dissections. We thank Karangelis and Tagarakis [1] for their kind comments about our article.

One of the aims of our article was to shed some light on this topic, and we are glad to stimulate scientific discussion.

The knowledge of the natural history of thoracic aortic pathology has enormously increased in the last years, and the evolution of the term ‘non-A non-B aortic dissection’ can be seen as a growing understanding of the pathophysiological process, which was initially described in 1994 [3].

We demonstrated, with the limitations due to the nature of the studies involved in the quantitative analysis, that the overwhelming majority of patients with non-A non-B dissections has a complicated course and that the mortality of patients treated with medical therapy is substantially higher compared to that of patients treated surgically or endovascularly. Thus, early intervention may be considered in patients with non-A non-B dissections.

However, according to our experience and to the recent position statement of a combined committee of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) [4], endovascular treatment should be limited to a more distal lesion (the proximal landing zone in zone 2) or to a patient deemed unfit for an open surgery, whereas more proximal lesions should be treated by means of open surgery mainly with the frozen elephant trunk, especially in cases of malperfusion.

In conclusion, we think that the treatment of non-A non-B aortic dissection should be tailored according to the morphology of the dissected aorta.

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