The majority of patients with acute type B dissection will fail medical therapy over time as evidenced by a 6-year intervention-free survival of 41%. Patients who underwent any aortic intervention had a significant survival advantage over those who were treated with medical management alone. Further study is necessary to determine who will benefit most from early intervention.

Nearly 40% of patients who present with an uncomplicated TBAD will ultimately require an aortic intervention. All of the late interventions were performed for aneurysmal degeneration. A variety of readily available anatomic features can predict the need for eventual operative intervention in TBAD; accordingly, these parameters can guide the desirability of early TEVAR.

Although medical management of uncomplicated acute, type B aortic dissections has been the standard of care, at 5 years, a significant number of patients will require operative intervention for aneurysmal degeneration. Further studies of early intervention (eg, thoracic endovascular aortic repair) for type B aortic dissection to prevent late aneurysm formation are needed.

Objective:We assessed umbilical cord tissue as a means of detecting fetal exposure to five classes of drugs of abuse.Study Design: In a multicentered study in Utah and New Jersey, we collected umbilical cord tissue when high-risk criteria were met for maternal illicit drug use. The deidentified umbilical cord specimens were analyzed for five drug classes: methamphetamine, opiates, cocaine, cannabinoids and phencyclidine. For each umbilical cord specimen, an enzyme-linked immunosorbent assay (ELISA)-based screening test was compared with a 'gold standard' test, consisting of gas or liquid chromatography tandem mass spectrometry.Result: A total of 498 umbilical cord samples were analyzed of which 157 (32%) were positive using mass spectrometric detection. The sensitivity and specificity of the ELISA-based test for each class of drugs tested were as follows: methamphetamine 97 and 97%, opiates 90 and 98%, cocaine 90 and 100%, cannabinoids 96 and 98% and phencyclidine (only 1 of the 498 umbilical cord sample was positive for phencyclidine) 100 and 100%. Conclusion:We judge that the performances of the ELISA-based tests are sufficient for clinical testing of fetal exposure to methamphetamine, opiates, cocaine and cannabinoids. Studies obtained on umbilical cord tissue can result in a more rapid return to the clinician than meconium testing, because waiting for meconium to be passed sometimes requires many days. Moreover, in some cases the meconium is passed in utero making collection impossible, whereas umbilical cord tissue should always be available for drug testing.

Income level correlates with advanced presentation, advanced age, and lack of statin use. Although primary assisted patency rate is not affected by income status, an increased cost-per-day of patency and inferior limb salvage is found in lower income patients.

Aortic diameter >44 mm is a predictor of mortality after adjustment for other significant risk factors. Age >60 years on admission is a predictor of mortality. An FL diameter >22 mm as well as those with maximum aortic diameter >44 mm on admission were associated with decreased intervention-free survival. Patients with these high-risk criteria may benefit from thoracic endovascular aortic repair. Further studies are needed to further define those patients at highest risk and, thus, most likely to benefit from early intervention.

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Background: The best management strategy for the left subclavian artery (LSCA) in pathologies of the aortic arch requiring zone 2 thoracic endovascular aortic repair (TEVAR) remains controversial. We compared LSCA coverage with or without revascularization.Methods: A retrospective record review was conducted of patients with all aortic pathologies who underwent zone 2 TEVAR deployment from 2007 to 2014. Primary outcomes included 30-day stroke, spinal cord injury (SCI), freedom from reintervention, aortic related mortality, and all-cause mortality.Results: We identified 96 patients (61.5% male) with zone 2 TEVAR that met our inclusion criteria. Mean patient age was 62 years. Pathologies included acute aortic dissections (n ¼ 25), chronic aortic dissection (n ¼ 22), aortic aneurysms (n ¼ 21), penetrating aortic ulcers/intramural hematomas (n ¼ 17), and traumatic aortic injuries (n ¼ 11). Strategies for the LSCA in zone 2 TEVAR included coverage (n ¼ 41) or LSCA revascularization (n ¼ 55). Methods of LSCA revascularization included laser fenestration with stenting (n ¼ 33) and surgical revascularization with transposition (n ¼ 10) or bypass (n ¼ 12). There was no difference in demographics between the different LSCA treatment strategies. Of the 55 patients who underwent LSCA revascularization, 44 (45.8%) underwent LSCA intervention at the time of TEVAR, and 12 (12.5%) underwent LSCA intervention at a mean time of 33 days before TEVAR (range, 4-63 days). For the entire 96 patient cohort, the overall incidence of 30-day stroke was 7.3%, and 30-day SCI was 2.1%. At a mean follow-up of 24 months (range, 79 months), aortic-related reintervention was 16.7%, aortic related mortality was 13.5%, and all-cause mortality was 29.2%.