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January 27, 2020

SVS and STS Announce New Reporting Standards for Type B Aortic Dissections

January 27, 2020—The Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) released new reporting standards to ensure patients with type B aortic dissection (TBAD) receive appropriate treatment and care. Joseph V. Lombardi, MD, the SVS Co-Chair, and G. Chad Hughes, MD, the STS Co-Chair, et al published the document online ahead of print in Journal of Vascular Surgery.

According to the announcement, the document is a combined effort by the societies that provides a unified consensus on reporting, nomenclature, and classification of TBAD, which remains a life-threatening problem whose treatment has been confused by differences in nomenclature and terminology.

The societies noted that the care of patients with TBAD has evolved over time and now includes medical, surgical, and endovascular therapies, often in a multidisciplinary environment, and performed by several specialties, including vascular surgery, cardiothoracic surgery, interventional radiology, and cardiology.

The SVS/STS reporting standards introduce a new classification system with several new and easy-to-use features created by combining previous classification systems with the well-known anatomic zones of the aorta. The document serves as an essential tool by providing a common language around dissections for clinicians, investigators, industry partners, and regulatory agencies.

The press release highlighted that another important area in the document is the need for a clear and consistent definition of chronicity of aortic dissections. The new standards also provide definitions of uncomplicated and complicated dissections and include a new high-risk category of dissections that is defined by the presence of specific ominous clinical and radiographic features when a patient presents with a TBAD. These reporting standards also provide strict definitions of the common clinical complications of dissections and how they should be described and reported.

In the societies' joint announcement, Dr. Lombardi commented, “The new classification system provides an easy way to be descriptive of patients’ anatomy using language that is relevant to the way we currently treat patients.”

Dr. Hughes stated, “The new reporting standards represent the culmination of more than a year’s long effort by a writing team consisting of subject matter experts from the SVS and STS. The multidisciplinary input from both vascular and cardiothoracic surgeons is unique and has resulted in a document that will define proper reporting for this complex topic. Uniform reporting will allow standardized comparisons across series between different institutions worldwide with the goal being data that will best inform outcomes and guide best practices going forward.”

Dr. Lombardi added, “With the recent blanket United States FDA approval of endovascular stent grafting for TBAD, as well as our maturing understanding of the anatomy and pathophysiology of the disease, there has been an explosion of literature in multiple specialty journals regarding TBAD presentation, treatment, and outcomes. The purpose of this document is to provide structure to the reporting of TBAD, with particular attention to those attributes of TBAD that, based on the best available evidence to date, would appear to impact outcomes.”

Finally, Dr. Hughes advised, “The document addresses a number of limitations of the current literature by bringing consistency to all aspects of [TBAD] reporting such as definitions of dissection chronicity, complicated versus uncomplicated versus high-risk dissection status, classification of dissections involving the aortic arch that are not well described using the current Stanford and DeBakey systems, as well as a uniform definition of aortic remodeling, among others.”

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