Uncomplicated Type Research Articles

Thoracic endovascular aortic repair for uncomplicated Type B aortic dissection: What is the optimal time window for intervention?

Uncomplicated Type B aortic dissection (un-TBAD) is still managed conservatively with optimal medical therapy (OMT) despite evidence in favour of thoracic endovascular aortic repair (TEVAR) for un-TBAD. OMT aims to regulate heart rate and blood pressure and patients require long-term follow-up to evaluate the extent of dissection, however, many un-TBAD patients are lost to follow-up. Several trials and observational studies evaluated the use of TEVAR in combination with OMT in un-TBAD and proved the safety, effectiveness, and comparability of TEVAR relative to OMT alone. What remains in question is the optimal time window to intervene with TEVAR. This was recently addressed in a fascinating review by Jubouri et al. AIMS: This commentary aims to discuss the recent review by Jubouri et al. which further proved that TEVAR is safe and effective in un-TABD and investigated the optimal timing of TEVAR in un-TBAD. We carried out a literature search using multiple electronic databases including PUBMED and Scopus in order to collate research evidence on intervention timeframe and outcomes of TEVAR in un-TBAD. Performing TEVAR during the subacute phase of dissection (15-90 days since symptom onset) seems to be associated with less periprocedural complications compared to the acute phase, however, late outcomes (>30 days post-TEVAR) are comparable between the two groups and are superior to the chronic phase. The introduction of TEVAR in un-TBAD presents a paradigm shift in the management of un-TBAD and a potential move towards becoming the gold-standard treatment option for un-TBAD. Intervening with TEVAR within the first 90 days since symptom onset (acute and subacute un-TBAD) gives favourable outcomes relative to intervention in the chronic phase of dissection (>90 days since symptom onset), this is due to the dissecting septum becoming less compliant over time. TEVAR is a safe and effective treatment modality for un-TBAD with a survival benefit compared to OMT alone. Offering TEVAR during the subacute phase of dissection yields optimal results which are comparable to the acute phase but superior to the chronic phase.

Acute aortic syndromes: a review of what we know and future considerations.

Acute aortic syndromes represent a spectrum of life-threatening aortic pathologies. Prompt diagnosis and proper management of these syndromes are important in reducing overall mortality and morbidity, which remains high. Acute aortic dissections represent most of these aortic wall pathologies, but intramural haematomas and penetrating atherosclerotic ulcers have been increasingly diagnosed. Type A dissections require prompt surgical treatment, with endovascular options on the horizon. Type B dissections can be complicated or uncomplicated, and treatment is determined based on this designation. Complicated Type B dissections require prompt repair with thoracic endovascular aortic repair (TEVAR) becoming the preferred method. Uncomplicated Type B dissections require medical management, but early TEVAR in the subacute setting is becoming more prominent. Proper surveillance for an uncomplicated Type B dissection is crucial in detecting aortic degeneration and need for intervention. Intramural haematomas and penetrating atherosclerotic ulcers are managed similarly to aortic dissections, but more research is needed to determine the proper management algorithms. Multi-disciplinary aortic programmes have been shown to improve patient outcomes and are necessary in optimizing long-term follow-up.

Osteoporosis Prevalence and Correlates in Uncomplicated Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus (T2DM) is a common metabolic disorder at a pandemic proportion at present. Often T2DM is associated with microvascular (diabetic nephropathy, neuropathy, and retinopathy) and macrovascular complications (coronary artery disease, peripheral arterial disease, and stroke). Additionally diabetic osteopathy is a significant comorbidity of T2DM and is characterized by micro architectural changes that decrease bone quality leading to an increased risk of fragility fracture.

Normal to Enhanced Intrinsic Mitochondrial Respiration in Skeletal Muscle of Middle- to Older-Aged Women and Men With Uncomplicated Type 1 Diabetes

We interrogated mitochondrial respiratory function and content in skeletal muscle biopsies of healthy adults 30-72 years old with and without uncomplicated type 1 diabetes (T1D). Participants (12/9 women/men) with type 1 diabetes (48±11 years old), without overt complications, were matched to participants without diabetes (control) (49±12 years old). Participants underwent a vastus lateralis biopsy to assess mitochondrial respiratory function, mitochondrial content and cristae density. Mitochondria area density was 27% lower in those with T1D versus controls.

First-Line Pharmacotherapy for Incident Type 2 Diabetes: Prescription Patterns, Adherence and Associated Costs in Alberta

To use real-world data from Alberta, Canada to: (i) describe the prescribing patterns for initial pharmacotherapy for those with newly-diagnosed uncomplicated type 2 diabetes; (ii) describe medication-taking behaviours (adherence and persistence) in the first year after initiating pharmacotherapy; and (iii) explore health-care system costs associated with prescribing patterns.

The early diagnostic value of ankle-brachial index combined with feet electrochemical skin conductance for peripheral artery disease in type 2 diabetes.

Aims/IntroductionIn this paper, we focused on exploring the diagnostic and predictive clinical utility of ankle‐brachial index (ABI) in combination with feet electrochemical skin conductance (FESC) for peripheral artery disease (PAD) in Chinese patients with type 2 diabetes mellitus (T2DM).Materials and MethodsOverall, 183 Chinese T2DM patients were enrolled in this study. The patients were classified into three groups: Group 1 comprised of uncomplicated type 2 diabetics (n = 36), Group 2 consisted of patients with diabetic peripheral neuropathy (n = 103) whereas Group 3 patients displayed peripheral artery disease (n = 44). All patients underwent Sudoscan test using a Sudoscan (Paris, France) and ABI assessment.ResultsMultivariate logistic regression models revealed that FESC was an independent risk factor of developing PAD in patients with type 2 diabetes. The AUC for diagnostic, positive predictive and negative predictive value of ABI in combination with FESC for PAD were 0.907, 0.733 and 0.920, respectively. The specificity and sensitivity of ABI in combination with FESC for PAD were 0.914 and 0.750, respectively.ConclusionsAnkle‐brachial index in combination with FESC can accurately be used in early diagnosis of PAD.

Impact of Integrated Medication Reminders, Gamification, and Financial Rewards Via Smart Phone Application on Treatment Adherence in Uncomplicated Type II Diabetes Patients

Background: Poor medication adherence in type 2 diabetes mellitus (T2DM) leads to poor glycemic control. Materials and Methods: This randomized, open-labeled, controlled study recruited consenting adult patients with uncomplicated T2DM who were on daily oral antidiabetics with documented poor medication adherence (missing ≥20% of their prescribed doses in the past 15 days). Patients in the “incentive group” installed a digital therapeutics mobile app (KYT-Adhere) and received multiple daily medication reminders. Patients were asked to show the pill/(s) to the app before consuming the medication, after which the patients received “KYT-Points”; these would be converted into financial incentives after 3 months, provided that they maintained ≥80% medication adherence. These patients received incentives for 3 months and medication reminders for 6 months. “Control group” patients received standard care. Results: A total of 118/120 recruited patients completed the study; 59 each with similar baseline parameters were randomized to incentive and control groups. At baseline, medication adherence and HbA1c were comparable (adherence: 65.7±4.7% and 65.3±4.0%; HbA1c: 9.0±0.3% and 9.0±0.3% for incentive and control groups, respectively). Over the study duration, the incentive group showed a significant improvement in medication adherence (P < 0.001) and significant HbA1c reduction (P < 0.001). At study closure, the average medication adherence and HbA1c were significantly different between the two groups (adherence: 86.8±3.2% vs. 67.7±4.6%, P < 0.001; HbA1c: 7.3±0.2% vs. 8.2±0.3%, P < 0.001). Conclusion: Gamification through combining repeated medication reminders and rewards through a smartphone application brought about a behavioral change, which improved medication adherence and glycemic control among T2DM patients within 3 months and was sustained for 3 more months without rewards.

Timing of endovascular repair impacts long-term outcomes of uncomplicated acute type B aortic dissection

ObjectiveTo compare the 5-year outcomes of acute versus subacute thoracic endovascular aortic repair (TEVAR) in patients with uncomplicated acute type B aortic dissection (ATBAD). MethodsBetween March 2008 and September 2018, 238 consecutive patients with uncomplicated ATBAD underwent TEVAR in the acute or subacute phase and were analyzed retrospectively. The primary end points were all-cause death and aortic-related death. The secondary end point was a composite of the outcomes of death from any cause, rupture, new dissection, retrograde type A aortic dissection, endoleak, and late reintervention. Inverse probability treatment weighting was used to balance baseline characteristics. Weight-adjusted Kaplan-Meier estimate with landmark analysis and weighted Cox model were performed to assess time-to-event outcomes. ResultsIn the inverse probability treatment weighting-adjusted population, the 30-day mortality was 1.5% in the acute TEVAR group and 0% in the subacute TEVAR group (P = .24). The incidence of 30-day adverse events occurred in 16.8% and 6.9% patients in the acute TEVAR and subacute TEVAR groups, respectively (P = .13). At 5 years, there was no statistically significant difference in all-cause death (hazard ratio [HR], 1.50; 95% confidence interval [CI], 0.59-3.81; P = .39) and aortic-related death (HR, 1.11; 95% CI, 0.34-3.60; P = .86) between the two groups. The composite outcomes occurred in 30 patients (23.0%) in the acute TEVAR group and 18 patients (22.3%) in the subacute TEVAR group, respectively (HR, 0.67; 95% CI, 0.36-1.25; P = .20). However, a landmark analysis of the composite outcomes indicated that there was a significant interaction between treatment effect and time (Pinteraction = .01), with a significantly higher incidence of the composite outcomes in the acute TEVAR group compared with the subacute TEVAR group within 1 year (HR, 0.25; 95% CI, 0.08-0.79; P = .02), and a comparable rate between 1 and 5 years (HR, 1.25; 95% CI, 0.56-2.76; P = .59). ConclusionsAt the 5-year follow-up, no significant differences exist in the all-cause death and aortic-related death between acute and subacute TEVAR. However, acute TEVAR is associated with an increased rate of severe complications within 1 year, which suggests that performing TEVAR in the subacute phase of ATBAD may be the preferable option.

Evaluation of a Standardized Protocol for Medical Management of Uncomplicated Acute Type B Aortic Dissection

The goals of medical management for uncomplicated acute type B aortic dissection (TBAD) are to prevent expansion of the false lumen and malperfusion syndrome. This is accomplished with antihypertensive agents; however, medication selection and titration are typically provider dependent. Given the paucity of data on evidence-based management of this population, we hypothesized that a standardized TBAD medical management protocol would reduce resource usage and costs, without compromising patient outcomes.

Delay to Transfer Predicts a Worse Prognosis for Uncomplicated Type B Aortic Dissection

Acute type B aortic dissections (TBADs) can become complicated, necessitating surgical repair. Characterizing the predictors for, and outcomes of, TBADs that become complicated in a delayed fashion can be used to inform the treatment of patients who initially presented with uncomplicated TBADs.

Early Thoracic Endovascular Aortic Repair is Superior to Medical Therapy in Acute Uncomplicated Type B Aortic Dissection

Historically, treatment of acute type B aortic dissection (TBAD) has been primarily medical management via impulse control, with intervention reserved for complicated presentations. At present, early usage of thoracic endovascular aortic repair (TEVAR) has been increasing to treat TBAD. The primary aim of the present study was to evaluate readmissions and treatment failure of TEVAR vs medical management alone as the initial treatment strategy for acute uncomplicated TBAD.

Aortic enlargement in two weeks is associated with subsequent aortic events in patients with type B acute aortic syndrome

ObjectivesTo determine whether aortic enlargement in 2 weeks in patients with type B acute aortic syndrome is associated with aorta-related adverse events. MethodsThis retrospective, single-center study included 183 patients who were diagnosed with uncomplicated type B acute aortic syndrome (classic aortic dissection and intramural hematoma) between 2010 and 2019 and had follow-up computed tomography at second or third week. Aortic diameter was measured at admission and at predischarge follow-up. Aorta-related adverse events were defined by a composite of aortic rupture, surgical or endovascular aortic repair, redissection, severe intestinal malperfusion, and aortic enlargement. ResultsThe patients whose aortic diameter enlarged ≥2 mm but <5 mm in 2 weeks were categorized as moderate aortic enlargement group. During follow-up, 51 patients (28%) had aorta-related adverse events and 36 patients (20%) had moderate aortic enlargement. Patients with moderate aortic enlargement showed lower aorta-related event-free survival rates than those without moderate enlargement (48 ± 9% vs 90 ± 3% at 1 year, P < .001). On multivariable analysis, moderate aortic enlargement (subhazard ratio, 3.64; 95% confidence interval, 2.08-6.35; P < .001) and aortic diameter ≥40 mm at admission (subhazard ratio, 2.96; 95% confidence interval, 1.60-5.48; P < .001) were associated with aorta-related adverse events. ConclusionsModerate aortic enlargement in 2 weeks is a significant risk factor of aorta-related adverse events in patients with uncomplicated type B acute aortic syndrome. Patients with moderate aortic enlargement should be followed up carefully and may be candidates for subsequent endovascular treatment.

Effect of glucose on reduced glutathione level in Malay uncomplicated type 2 diabetes patients

Background: Increasing blood sugar level may increase free radical compounds in type 2 diabetes. Free radical compounds can cause oxidative stress, thereby decreasing endogenous antioxidants such as reduced glutathione (GSH).&#x0D; Objective: This study aimed to determine whether random blood glucose levels affect GSH in type 2 diabetes patients within the Malay race.&#x0D; Methods: This study was observational with case-control, involving 25 patients with uncomplicated type 2 diabetes (receiving metformin and/or glimipiride) and 25 healthy controls. Random blood glucose levels were determined using ACCU-CHECK® Kit. Blood GSH levels were determined by Sigma GSH Assay Kit.&#x0D; Results: Results show that type 2 diabetes patients have a significantly lower random blood glucose level compared with those of age-matched normal subjects (p&lt;0.0001). Type 2 diabetic patients had significantly lower levels of GSH (p=0.00) than those of age-matched normal subjects. We found a moderate negative correlation (r=-0.437 and p=0.02) between the level of random blood glucose and the level of GSH.&#x0D; Conclusion: The depletion of GSH during hyperglycemia may neutralize the free radicals indirectly generated by the abundant of glucose.&#x0D;

Evaluation of the Effects of Abdominal Liposuction in Improving Metabolic Parameters in Recently Diagnosed Non Complicated Type 2 Diabetes

Abstract Background: Diabetes Mellitus (DM) is a metabolic disorder characterized by the presence of chronic hyperglyc-emia accompanied by greater or lesser impairment in the metabolism of carbohydrates, lipids and proteins. DM is probably one of the oldest diseases known to man. It was first reported in Egyptian manuscript about 3000 years ago. In 1936, the distinction between type 1 and type 2 DM was clearly made. Type 2 DM was first described as a component of metabolic syndrome in 1988. The origin and etiology of DM can vary greatly but always include defects in either insulin secretion or response or in both at some point in the course of disease. Obesity is associated with an increased risk of premature death and significantly increases the risk of developing type 2 diabetes mellitus, hypertension, coronary heart disease. Dyslipidaemia is a silent pandemic affecting millions of people around the world. There is controversy of the possible benefit of liposuction or abdominoplasty in the metabolism of glucose or cholesterol. Liposuction was the second most frequently performed aesthetic operation in 2013. As with any surgery liposuction carries risks, however, in recent years, improved techniques have made liposuction safer, easier, and less painful. Thus, any intervention that immediately decreases adiposity and is relatively safe could be a viable method not only for aesthetic purpose but also for increasing the efficiency of insulin and improving metabolic profile, especially when combined with regular exercise and proper diet. Aim of Study: The aim of this study is to evaluate the effectiveness of abdominal liposuction in improving quality of life in newly diagnosed uncomplicated type 2 diabetic patients. Patients and Methods: This study will take place in plastic Surgery Department, Port Said general Hospital. As total number of cases satisfying inclusion criteria not exceed 6 cases the study period (During 2019-2020) the total sample 3x6=18 cases all will be included as comprehensive sample. Results: In our study, the mean FBG was 163±22mg/d1 preoperatively. At three months after surgery, it was 162±29mg/dl, but at six months after surgery, it was 147± 28mg/d1. The mean PPBG was 218±40mg/d1 preoperatively. At three months after surgery, it was 216±40mg/dl, but at six months after surgery, it was 200±34mg/d1. The mean HbAlc percentage was 8±0.8% preoperatively. At three months after surgery, it was 7.7±0.8%, but at six months after surgery, it was 7.6±0.8%. The mean triglyceride level 48 preoperatively. At three months after surgery, it was 162±41, but at six months after surgery, it was 159±49. The mean cholesterol was 207 ±42 preoperatively. At three months after surgery, it was 197 ±52, but at six months after surgery, it was 189±41. The HOMA-IR was 3±0.7 preoperatively. At three months after surgery, it was 2.8±0.7, but at six months after surgery, it was 2.8±0.7. All the laboratory investigations change over time among the studied patients were not statistically significant. Conclusion: So, we can conclude that large volume ab-dominal liposuction should not, by itself, be considered a clinical therapy for type 2 diabetes mellitus. Aspiration of large amounts of subcutaneous abdominal fat in diabetic patients, despite having cosmetic benefits, It does not signif-icantly improve insulin sensitivity through altering serum levels of obesity markers. Therefore, the procedure is safe and may could successfully help diabetic subjects to reduce their potential metabolic risks. Therefore, abdominal Liposuc-tion is effective scarless operation for subcutaneous adipose fatty tissue reduction.

Evaluation of a Standardized Protocol for Medical Management of Uncomplicated Acute Type B Aortic Dissection

The goal of medical management for uncomplicated acute type B aortic dissection (TBAD) is to prevent expansion of the false lumen and malperfusion syndrome. This is accomplished with antihypertensive agents, but medication selection and titration are typically provider dependent. Given the paucity of data on evidence-based management of this population, we hypothesized that a standardized TBAD medical management protocol would reduce resource utilization and costs, without compromising patient outcomes.

Risk Factors Predicting for Perioperative and Long-Term Mortality in Acute and Subacute Thoracic Endovascular Aortic Repair Patients

The use of thoracic endovascular aortic repair (TEVAR) technique to treat patients with both uncomplicated and complicated acute type B aortic dissections (TBAD) has continue to increase; however, limited national data exist evaluating the outcomes and predictors of adverse events. We used prospectively collected data from the Vascular Quality Initiative to evaluate (1) the presentation and clinical features of acute aortic dissections, (2) the incidence of outcomes, and (3) the predictors of these outcomes.

Outcomes of Thoracic Endovascular Aortic Repair for Uncomplicated Type B Dissections Based upon Chronicity

The long-term results of thoracic endovascular aortic repair (TEVAR) and medical management for uncomplicated type B dissection (uTBD) has been associated with improved aorta-specific survival and delayed disease progression. Recently the Society for Vascular Surgery and the Society for Thoracic Surgeons published new reporting standards for TBD. We assessed the effectiveness of TEVAR in the treatment of uTBD by the updated classification using the Vascular Quality Initiative.

Early Thoracic Endovascular Aortic Repair Is Superior to Medical Therapy for Acute Uncomplicated Type B Aortic Dissection

Historically, treatment of acute type B aortic dissection (TBAD) has primarily been medical management via impulse control, with intervention reserved for complicated presentations. At present, the early use of thoracic endovascular aortic repair (TEVAR) to treat TBAD has been increasing. The primary aim of the present study was to evaluate readmissions and treatment failure of TEVAR vs medical management alone as the initial treatment strategy for acute uncomplicated TBAD.

Five-Year Mortality and Freedom From Intervention After Medical Management of Type B Aortic Intramural Hematoma

Medical management centered around anti-impulse therapy and serial imaging is recommended for uncomplicated type B aortic intramural hematoma (IMH). The aim of this study was to evaluate the natural history of medically treated aortic IMH and identify factors that portend failure of medical management. Data from consecutive patients diagnosed with type B IMH from 1995 to 2019 were retrospectively reviewed. Primary outcome was 30-day mortality. Secondary outcomes included all-cause and aortic-related mortality, and aortic-related surgical intervention for dissection or aneurysm. Demographics, clinical, and anatomic data and management details were analyzed. Ninety-one patients were identified with type B IMH: 78 acute, 6 subacute, 1 chronic, 5 incidental, and 1 traumatic. All patients received antihypertensive medications and pain control. The initial management was best medical therapy (BMT) in 85% (N = 77) and surgery in 13% (N = 12) of patients. Two patients declined intervention and died within 48 hours. Thirty-day mortality was 5% (N = 4) in the BMT and 17% (N = 2) in the surgery treatment group. All-cause 5-year mortality was comparable between groups (57% vs 50%, P = .8), with a median survival of 6.8 years (interquartile range [IQR]: 2.4-10.9 years) after BMT and 5.9 years (IQR: 1.4-7.7 years) after surgery. However, 5-year aortic-related mortality was higher in the surgical group (25%) compared with BMT (4%, P = .02, Fig) due to high perioperative mortality. Aortic-related intervention after initial medical management was required in 19% (N = 15) of patients, for dissection (N = 3) and aneurysm (N = 12). The median freedom from intervention was 4.6 (IQR: 1.4-9.2) years. On univariate analysis, coronary artery disease, hypertension, baseline creatinine level, peripheral artery disease, active smoking, IMH thickness, and maximum aortic diameter were independent risk factors for a subsequent need for surgery after medical management (Table). On multivariate analysis, chronic kidney disease with a creatinine >1.2 mg/dL, IMH thickness (>7.7 mm), and aortic diameter (>42 mm) were predictive risk factors. Reintervention after initial surgical management was required in 25% (N = 3), for aneurysm, endoleak, and infected endograft with a median freedom from reintervention of 5.2 (IQR: 3-7.9) years. Medical management of type B IMH is associated with low early mortality but a 19% risk of aortic-related intervention, primarily for proximal descending thoracic aneurysm. Elevated creatinine, IMH thickness, and aortic diameter at presentation portend eventual failure of medical management. Given the nearly 5-year time between IMH and need for surgery beyond 30 days, diligent follow-up is needed. These findings provide useful information to guide patient expectations and optimal treatment.TableUnivariate analysis of baseline risk factors for need for surgical intervention after medical managementVariableBMT onlyBMT + surgeryP valueDemographics N6215 Male sex34 (55%)10 (67%).2 Age at symptom onset, years77 (47-92)76 (56-88).3 BMI, kg/m227.2 ± 6.028.2 ± 4.4.7Baseline comorbidity status Coronary artery disease17 (27%)14 (93%).01 Myocardial infarction11 (18%)2 (13%).8 MI within past 30 days2 (3%)1 (7%).5 Unstable angina7 (11%)0.2 CABG5 (8%)1 (7%).9 CABG within past 6 weeks1 (2%)0.6 Arrhythmia13 (21%)3 (20%).9 CHF10 (16%)3 (20%).7 EF<30%3 (5%)0.4 Hypertension48 (77%)14 (93%).02 Hyperlipidemia22 (35%)7 (47%).4 Current smoker15 (24%)10 (67%).03 Former smoker12 (19%)4 (27%).7 COPD10 (16%)2 (13%).8 Severe COPD on steroids/home O23 (5%)0.4 Diabetes mellitus6 (10%)0.2 Stroke/TIA11 (18%)3 (20%).4 PAD9 (15%)0.04 Baseline creatinine1.1 ± 0.62.3 ± 1.0.01 Creatinine > 35 (8%)5 (33%).02Presentation Acute5114.7 Subacute41 Chronic10 Incidental imaging finding50 Traumatic10Aortic segments involved Distal arch36 (58%)10 (62%).8 Descending thoracic59 (95%)15 (9100%).4 Suprarenal22 (35%)3 (20%).3 Infrarenal7 (11%)0.1Imaging at presentation IMH thickness, mm7.6 ± 48.3 ± 4.04 Aortic diameter, mm40.1 ± 9.347.8 ± 6.2.03 Associated PAU30 (40%)9 (60%).4Vital signs at presentation Heart rate, per min76 ± 1574 ± 16.4 Systolic BP, mm Hg158 ± 35152 ± 35.3Boldface P values represent statistical significance. Open table in a new tab

TEVAR for complicated anduncomplicated type B aortic dissection-Systematic review and meta-analysis.

Type B aortic dissection (TBAD), is defined as a dissection involving the aorta distal to left subclavian artery with the ascending aorta and the aortic arch not affected. TBAD is classified due to the time frame and presence of complications. Complicated TBAD (co-TBAD) patients have a greater mortality rate than uncomplicated TBAD (un-TBAD) and thoracic endovascular aortic repair (TEVAR) is considered the gold-standard intervention for these clinical challenges. We undertook a systematic review of the literature regarding TEVAR intervention in co-TBAD and un-TBAD. A comprehensive search was undertaken across four major databases and was evaluated and assessed until June 2020. A total of 16,104 patients were included in the study (7772 patients co-TBAD and 8352 un-TBAD). A significantly higher proportion of comorbidities were seen in co-TBAD patients compared with un-TBAD. Acute dissection was more frequent in the co-TBAD group (73.55% vs. 66.91%), while chronic dissection was more common in un-TBAD patients (33.8% vs. 70.73%). Postprocedure stroke was higher in co-TBAD (5.85% vs. 3.92%; p < .01), while postprocedural renal failure was higher in un-TBAD patients (7.23 vs. 11.38%;p < .01). No difference was observed in in-hospital mortality however the 30 days mortality was higher in the co-TBAD group. One-year survival was higher in the uncomplicated group but this difference was not observed in the 5-year survival. In our analysis we can appreciate that despite significantly higher comorbidities in the co-TBAD cohort, there was no difference in in-hospital mortality between the two groups and the 5-year survival did not have any difference.