![]() There are two primary hypotheses that have been proposed to explain acute aortic dissection. The media is the largest layer and is composed of muscle and connective tissue, while the adventitia is a thin layer of connective tissue ( 6). The intima, being in direct contact with blood, is a thin layer primarily composed of endothelial cells on a basement membrane. The aorta, similar to other arteries, is composed of three layers from deep to superficial: intima, media, and adventitia. However, data on the optimal diagnostic and treatment modalities for type III, also known as type B dissection, was slow to evolve throughout the latter half of the twentieth century even as newer diagnostic techniques and management strategies became commonplace. The Stanford classification was developed in the 1970s and it further highlighted the differing clinical practices in management of ascending vs. identified clinically distinct variants of aortic dissection as type I and II originating in the ascending aorta and type III originating in the descending aorta ( 4), and that descending aortic dissection significantly differed from ascending aortic dissection with regards to presentation and outcomes. However, it was not until the mid-twentieth century that the first large case series was published ( 2) and the first surgical resection was performed ( 3). Thus, we present herein three areas in which IRAD data has recently advanced our understanding of acute type B aortic dissection: temporal classification especially for the subacute time period, risk stratification for identifying complicated cases, and thoracic endovascular aortic repair (TEVAR).Īortic dissection is a catastrophic cardiovascular condition first described in detail by Frank Nicholls in his necropsy report of King George II ( 1). Specifically in recent years, analyses of IRAD data have gone beyond simply characterizing the patient with acute type B aortic dissection and have attempted to identify the means by which the outcome of such a patient could be improved. ![]() Over the past two decades, IRAD publications have steadily increased our knowledge and understanding about aortic dissection. To further elucidate contemporary practice patterns and outcomes of aortic dissection, the International Registry of Acute Aortic Dissection (IRAD) was established in 1996. Although this catastrophic cardiovascular condition was first described in the medical literature over two centuries ago, data on the optimal diagnostic and treatment modalities for type B dissection was slow to evolve throughout the latter half of the twentieth century, even as newer diagnostic techniques and management strategies became commonplace. Acute type B aortic dissection comprises approximately one-third of all aortic dissection cases.
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