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Review

Type B Aortic Dissection Management Strategies: National Survey, Systematic Review, and Pooled Clinician Perceptions

by
Ali Kordzadeh
1,* and
Karen May Rhodes
2
1
Department of Vascular, Endovascular and Renal Access Surgery, Mid & South Essex NHS Foundation Trust, Basildon Hospital, Nether Mayne, Basildon SS16 5NL, Essex, UK
2
Department of Emergency Medicine, Mid & South Essex NHS Foundation Trust, Broomfield Hospital, Chelmsford CM1 7ET, Essex, UK
*
Author to whom correspondence should be addressed.
J. Vasc. Dis. 2026, 5(1), 2; https://doi.org/10.3390/jvd5010002
Submission received: 28 November 2025 / Revised: 31 December 2025 / Accepted: 13 January 2026 / Published: 20 January 2026
(This article belongs to the Section Cardiovascular Diseases)
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Abstract

Background: Type B Aortic Dissection (TBAD) management relies on risk stratification, yet evidence-based tool adoption remains inconsistent in National Health Services (NHSs). Bridging the gap between Emergency Medicine (EM) and Vascular Surgery remains essential for timely diagnosis, optimal risk stratification, and appropriate intervention to improve outcomes and reduce mortality. Methods: A cross-sectional survey of EM consultants yielded n = 173 valid responses from n = 33 units across the UK. Subgroup analyses were conducted using a Chi-square test (p < 0.05) alongside descriptive analysis. A pooled prevalence analysis of the literature, utilizing a random-effects model at a 95% confidence interval (CI), served as a benchmark for perception analysis. Agreement was evaluated using Bland–Altman analysis, incorporating upper, lower, and overall bias of agreeability. Results: Access to a rapid Computed Tomography Angiogram (CTA) was 70% (95% CI: 63.3–76.8%, p < 0.001), while 32% had standard operating procedures (SOPs) for TBAD (95% CI: 25.3–39.1%), and 26% were aware of any decision tool (95% CI: 20.6–33.6%). Labetalol as a first-line antihypertensive was more common amongst least experience (p < 0.05). TBAD diagnosis increased 1.6-fold with every 4 years of additional experience (p < 0.05). Perception analysis showed strong agreement for pain (characteristics and location), hypertension, gender, and age with moderate-to-low agreement for other factors with a reported bias of 23.58% (−38.20% to 85.36%) (p = 0.02). Conclusions: The survey suggests a degree of misperception and inconsistency in recognition of most and least prevalence factors for TBAD suspicion and management. This outcome advocates targeted strategies to enhance diagnostic accuracy using tools aligned with NHS resources and QALY frameworks. Furthermore, upon recognition of the most prevalent factors, CTA and specialist referral is advocated.

1. Introduction

Acute aortic dissection (AAD) remains the most common life-threatening condition affecting 3 to 6 per 100,000 individuals with incidences exceeding that of ruptured abdominal aortic aneurysms [1,2]. Their presentation continues to pose a significant challenge, and chest pain as a constitutional symptom accounts for millions of visits to the emergency departments (EDs). Prompt and accurate diagnosis is essential, as delayed or misdiagnosis occurs in 14–38% of cases and is associated with 22.7% mortality within the initial 6 h and 50% at 24 h [3,4,5]. The International Registry of Acute Aortic Dissection (IRAD) highlighted that approximately 40% of AADs are classified as Type B Aortic Dissection (TBAD) [6]. However, the recent collaboration between the National Vascular Registry (NVR), Hospital Episode Statistic (HES), and National Institute of Cardiovascular Outcomes Research (NICOR) in England alone stated that amongst n = 6994 cases of AAD from 2017 to 2022, 60% were TBAD [7].
The lack of classical signs and constitutional symptoms in TBAD continues to challenge emergency physicians in their prompt recognition [8,9]. Furthermore, the complex interplay of hemodynamic and anatomical factors demands a comprehensive and systematic management from their earliest onset to achieve optimal outcome [10,11,12]. The recent report by the UK Healthcare Safety Investigation Branch indicated that AAD impacts approximately 2500 individuals annually [13]. This report indicated that the low frequency of cases, combined with a lack of robust detection strategies, continues to contribute to mortality and morbidity.
From a surgical perspective, advancements in technology have led to better outcomes, particularly when combined with non-operative management. However, whilst efforts focus on those that are diagnosed and treated, the issue of misdiagnosis or delayed diagnosis has not been evaluated. Given the patient journey begins in the ED, it is essential for Emergency Medicine (EM) consultants to maintain a high index of suspicion to minimize diagnostic delays [13]. Taking the aforementioned factors into account, this survey was primarily designed to capture the current perception, knowledge, and awareness of EM Consultants regarding TBAD within the wider NHS. This survey was inclusive of baseline information such as signs, symptoms, diagnostic criteria, management strategies, infrastructure, ongoing care, and educational aspects of TBAD. The secondary aim focused on comparison of the current survey results to that of national and international standards, guidelines, and policies, and, if deemed necessary, recommends refinements to improve prompt diagnosis and raise awareness with an objective methodology.

2. Methods

A review of the literature to identify existing scoring, stratification, and/or predictive tools that provide insight to relevant data pertaining to signs, symptoms, clinical findings, and risk factors was conducted. This was an electronic and systematic search in Medline on predictive and/or risk stratification tools for the diagnosis of Type-B Aortic Dissection (TBAD). This review focused on those articles that included demographics, signs, symptoms, clinical findings, risk factors, and primary biomarkers for their predictive or risk stratification methodology. The search was limited to English language and adults only. (Supplementary Data) Data extraction was conducted by two independent reviewers and subjected to inter-rater reliability agreement (Cohen’s kappa coefficient). A value greater than 0.8 indicated good agreement [14,15]. The search outcome served as the foundation for the clinical section of the survey and point of reference for the perception analysis. This survey was a collaborative effort of Vascular Surgery & Emergency Medicine (Supplementary Information). This survey was also evaluated in line with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) (Supplementary Information).

2.1. Survey Details

An electronic consultant-based survey was designed. This survey was forwarded to the administrator of the individual Schools of Emergency Medicine (EM) within the National Healthcare System (NHS) for dissemination. The survey was voluntary, with no obligation or incentives. None of the participants were aware of the contents of the survey. This survey contained no patient data or alteration of routine practice. The authors contribution list contains those that consented to their name and unit with no attribution to the results. The survey was disseminated electronically to EM consultants only within the NHS. The survey comprised a total of n = 19 questions entailing n = 63 data points (Supplementary Data) over a 9-month period. A total of n = 173 consultants across Wales, Scotland, and England from n = 33 units (n = 13 district general, n = 11 tertiary, and n = 9 university hospitals) responded. The outcome was automatically recorded on completion with no missing data. This survey comprised two distinct sections. The initial part focused on the experience of individual EM consultants, prior involvement, and knowledge regarding (inclusion and/or exclusion) criteria for diagnosis of TBAD. The second section evaluated the initial management strategy, specialty disposition, definitive care plan, awareness of clinical scoring systems, and standard operating procedures (SOPs). This survey also questioned the need for a national risk stratification tool/s and education in TBAD. The final section of this article includes perception analysis comparing the survey outcome to that of pooled prevalence analysis.

2.2. Standard Operating Protocol (SOP) and Guidelines

  • Acute Aortic Syndrome (AAS): This term encompasses aortic dissection, penetrating aortic ulcer (PAU), and intramural hematoma (IMH) [16].
  • Type B Aortic Dissection (TBAD) and blood pressure management: TBAD is defined as a dissection occurring in the aorta beyond the left subclavian artery, without involving the ascending aorta. Labetalol is the recommended first line antihypertensive for management of hypertension in TBAD [16].
  • Rapid CTA, Reporting, and SOP: Guidelines recommend rapid CTA access and reporting alongside standard operating procedures (SOPs) for TBAD management in emergency settings [17,18,19].

2.3. Statistical Analysis

Prior to the dissemination of the survey, an initial power calculation identified that n = 150 consultant responses would be adequate to achieve 80% power at a 95% confidence interval (95% CI), assuming an effect size sufficient to prevent conclusion bias with an estimated proportion of 0.5. A total of n = 173 consultants with no missing data from the UK (Wales, Scotland, and England) and n = 33 units (n = 13 district general, n = 11 tertiary, and n = 9 university hospitals) responded to this survey. This study employed a cross-sectional survey design to evaluate the experiences, practices, and perceptions of EM consultants in the diagnosis and management of TBAD. The initial data output was subjected to descriptive analysis. This included the percentage and count for binary data and was complemented by 95% CIs for polynomials. Inferential analysis was conducted using the binomial test, an exact test for assessing the statistical significance of deviations from a theoretical expected distribution of binary outcomes, as defined by acknowledged and practiced criteria. This was applicable to the use of Labetalol (beta-blocker) as a first-line antihypertensive, the presence of standard operating procedures (SOPs), access to rapid CTA and reporting, awareness of decision tools, and the inclusion of TBAD in local educational programs as per guidelines and definitions [15,16,17,18].
Subgroup Analysis: Initial analysis was complemented by subgroup analysis based on the experience of consultants per year, categorized into three groups, Group-1 (0–4 years), Group-2 (5–10 years), and Group-3 (>10 years), as per the questionnaire. The Chi-square test was utilized to assess whether consultants with varying levels of experience responded differently to specific aspects of the survey by comparing observed and expected frequencies within a 95% confidence interval (CI). A probability value (p-value) of less than 0.05 was considered statistically significant [20].
Pooled and Perception analysis: The extracted data from the primary review of the literature on all endpoints of the survey was subjected to a pooled prevalence analysis using a random-effects model at a 95% confidence interval (CI) [21]. This analysis served as a benchmark to evaluate respondents’ estimated perceptions in the survey. Perception analysis utilized a Bland–Altman methodology to evaluate the agreement between the survey and pooled outcomes. This approach involved assessing the differences between the two outcomes and plotting them against their averages. Systematic bias (mean difference) and limits of agreement, calculated as ±1.96 SD of the differences, were determined. The lower confidence limit (LCL) and upper confidence limit (UCL) were identified to provide thresholds within which most differences would fall [22]. The results are presented using a Bland–Altman plot and radar chart to illustrate the levels of agreeability and any disparities [23,24].

3. Results

Primary Outcome: Amongst 173 consultants, 41% had more than 10 years of experience. The majority reported prior involvement in managing TBAD and considering it as a differential for chest pain. The key clinical signs prompting suspicion were pain severity and location, hypertension, neurological manifestations, and pulse deficits. Risk factors considered included connective tissue disorders, prior aortic surgery, and age. Raised D-dimer was the most common diagnostic trigger (44%), followed by raised lactate and normal Troponin-T. Labetalol was the preferred first-line antihypertensive, followed by Nitroglycerin (GTN). Cardiothoracic surgery was the most common specialty referral, followed by vascular surgery and internal medicine. Management occurred at tertiary centers in 47% of cases. Implementation of a risk stratification was perceived to be useful by the majority of the cohort. Overall, the majority indicated that TBAD was included in their educational programs (Table 1).
Subgroup outcome: Access to rapid CTA and reporting was noted in 70% of respondents. However, only 32% reported the presence of SOPs for TBAD and only 26% were aware of any decision tools. The use of Labetalol (beta-blocker) as a first-line antihypertensive was more common among those with less experience. The diagnosis of TBAD showed a 1.6-fold increase with every additional 4 years of experience in the ED, p < 0.05. Furthermore, there was a 1.3-fold increase in the recognition of murmurs as a clinical prompt and a 2.6-fold increase in the likelihood of initiating a CTA based on a normal ECG for every 4-year increment in experience (Table 2).
Pooled Analysis Outcome: The analysis demonstrated that pain and location were identified as the most predominant factors at 76.4% (95% CI: 72.7–79.8%), followed by hypertension at 68.6% (95% CI: 61.5–74.9%), raised D-dimer at 61.8% (95% CI: 54.4–68.7%), and male gender at 66.5% (95% CI: 44.55–88.45%). The median age was 64.5 years (95% CI: 61–69 years) and all outcomes are detailed in Table 3 [16,25,26,27,28,29,30,31,32].
Perception Analysis Outcome: Strong agreement was observed in pain and location, and hypertension, with minimal differences clustering near the bias line. Moderate agreement was noted in raised D-dimer, connective tissue disorder, and aortic surgery, where data points remain within the limits of agreement. Pulse deficit, focal neurology, and murmur showed lower agreement, with differences nearing the limits of agreement and greater inconsistency. There was a bias of 23.58%, with limits of agreement from −38.20% (LCL) to 85.36% (UCL). This was statistically significant (p = 0.02) (Figure 1 and Figure 2).

4. Discussions

The survey reported a higher prevalence inclusive of clinical examination for murmur [33]. Additionally, aortic chromosomal abnormalities (e.g., Turner and Noonan syndromes) and hereditary conditions (e.g., Marfan and Ehlers–Danlos syndromes) are observed in younger populations (<40 years) compared to the general population [34]. Furthermore, cocaine uses with an incidence of 37% as a risk factor is more likely to result in TBAD (48%), exceeding the collective impact of the later risk factors [35].
The survey demonstrated that the majority considered TBAD in the differential diagnosis of chest pain, with a higher threshold to proceed to CTA when raised D-dimer, elevated lactate, or normal Troponin-T was observed. However, 30% (95% CI: 23.2–36.7%) lacked rapid access to prompt CT imaging and reporting, despite CT being the most accurate diagnostic modality [36]. This is of concern when misdiagnosis was reported by a quarter of the respondents in the survey.
Mal-perfusion syndrome or so-called complicated TBAD is caused by end-organ ischemia due to aortic branch involvement that accounts for 20–31% of all TBAD cases [37]. Its presentation can resemble transient ischemic attacks (TIAs) or manifest as acute limb or organ ischemia [28]. While signs such as pulse deficits, focal neurology, murmurs, nausea, and vomiting may suggest Mal-perfusion, these features are uncommon in uncomplicated TBAD. Furthermore, placing equal emphasis on less consistent signs compared to more common indicators may represent an overestimation.
Upon diagnosis, Labetalol was the preferred first-line antihypertensive, although its preference decreased with increasing experience in practice, despite clear guidelines (Group: 1 100% vs. Group: 2: 92.6% vs. Group: 3: 86.9%), p < 0.05. Among respondents, 19% (95% CI: 13.9–25.5%) reported using GTN, despite the literature recommending its use only after beta-blockers. This is due to the risk of sympathetic stimulation from direct vasodilation, which can lead to increased dP/dT because of catecholamine release [38]. Furthermore, there was a notable lack of SOPs in emergency departments for TBAD. EM consultants were more likely to involve cardiothoracic surgeons and acute physicians rather than vascular surgeons (p = 0.01) as the primary point of reference and management.
The perception analysis revealed some overestimation, which also has two positive implications. First, it suggests a strong awareness of the signs and symptoms amongst consultants in ED. Secondly, overestimation is preferable when predicting risk in clinical settings, especially when the stakes are high [39]. Furthermore, increased clinical experience correlated with a higher rate of TBAD diagnosis. The inclusion of normal ECG as a diagnostic aid in this survey (9%), despite its absence from most stratification scores, aligns with recent evidence that normal ECG are observed in 20–30% of TBAD cases [40].
The survey suggests inconsistency and varied perception in TBAD stratification and management. This outcome advocates targeted strategies to enhance diagnostic accuracy using tools aligned with NHS resources and QALY frameworks [41]. Unified local and national educational initiatives should prioritize improving awareness, with a secondary goal of establishing standardized operating procedures (SOPs) that comprehensively cover the entire care pathway, from diagnosis to specialty deposition. Achieving this objective demands a realistic and collaborative approach involving all stakeholders. Furthermore, integrating data and coding systems is essential to gain a better understanding of this complex pathology, which continues to present significant challenges to involved specialties.
Overall, the diagnosis should not solely rely only on fixed clinical patterns, due to varied presentations. A low threshold for CTA is essential when the diagnosis cannot be excluded. This aligns with recommendations from the Royal College of Emergency Medicine (RCEM), the Royal College of Radiologists (RCR), and the Healthcare Safety Investigation Branch. Within NHSs, regional Aortic Dissection Networks, 24 h imaging access, and shared imaging support rapid diagnosis. Remaining challenges include limited scanner capacity, radiology delays, and communication gaps, highlighting the need for clearer pathways and targeted training.

5. Limitations

While this survey provides valuable insights into current practices and gaps in the management of TBAD, it has several limitations that warrant consideration. First, the survey relies on self-reported data, which may introduce recall bias alongside over- or underestimation of data points. Variability in access to resources, such as CTA or its rapid reporting, may also reflect institutional differences rather than broader systemic issues within NHSs. Furthermore, the survey does not account for regional disparities in training, experience, or access to multidisciplinary teams, which could influence reported practices.
This survey was based on categorical and numerical data points. A larger number would have enhanced the robustness of the study, enabling more reliable statistical inferences. It is important to note that the analysis depends on the accuracy of participant reporting. Additionally, the inclusion of more detailed categories and parameters would have provided a more comprehensive understanding of TBAD diagnosis or management. Finally, the lack of standardized definitions for some clinical parameters and outcomes, such as “misdiagnosis,” may lead to inconsistencies in interpretation.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/jvd5010002/s1, Table S1: The Survey; Table S2: Hospitals, Unit & Cities; Table S3: Checklist for Reporting Results of Internet E-Surveys (CHERRIES) [42]; Table S4: Subgroup analysis Per years of experience of consultants; Table S5: Literature & Search Methodology (Total articles identified n = 196); Figure S1: PRIMSA Flow CHART.

Author Contributions

Conceptualization, A.K.; Methodology, A.K.; Software, A.K.; Validation, A.K. and K.M.R. formal analysis, A.K.; Investigation, K.M.R.; resources, K.M.R.; data curation, K.M.R.; writing—original draft preparation, A.K. and K.M.R.; writing—review and editing, A.K. and K.M.R.; visualization, A.K. and K.M.R.; supervision, A.K.; project administration, A.K. and K.M.R.; funding acquisition, None. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not Applicable.

Informed Consent Statement

Not Applicable.

Data Availability Statement

Data are available upon reasonable request. Any data pertaining to this survey may be obtained in de-identified format from the corresponding author, provided reasonable request is made within an acceptable timeframe.

Acknowledgments

We would like to acknowledge the survery contributors: A. Alanood, Abdal Butt, Abdelrahman Abbas, Ajantha Kurukulasuriya, Alain vella, Aleinmar Winthein, Alison Macleod, Ammar Salem, Andy Ashton, Andy Webster, Angelo Giubileo, Angharad Spencer, Anna Bayston, Aszad Aya, B.Vivegananthan, Bianca Ebtehadj, Binu George, Brian Chivima, Catherine Botting, Clare Davies, Clare O’Leary, Dalip Kumar, Daniel Stanciu, David Hartin, David Maltby David Prosser, Donna wade, Ed Barnard, Francoise Sheppard, Georgina Robertson, Gyorgyi Kamaras, Heinrich Hollis, Helen Turner, Hunniya Waseem, Husnain Ali, Jamie Cooper, Jason Louis, Jim Crawfurd, John Lankester, Jonathan Scrimshaw, Kate Russ, Kh Gul Zaman Butt, Kirsten Walthall, Kirsty Challen, Lee Helliwell, Manoj Viegas, Martin Hunt, Mehdi Hassan Teeli, Mike Iacovou, Mohit Arora, Muhammad Sajid, Nadine Darlow, Natalie James, Neil Prater, Oliver Meller-Herbert, Polly Haywood, Rajesh Vasiraju, Ravishankar Prabhakar Shashikala, Rehman Raj, Rengarajan Subramanian, Rishi Rallan, Robert Taylor, Roopa Balasundaram, Sanjoy Bhattacharyya, Sarah Higgins, Sebastian Clark, Shanthi Siva, Sukhbir Singh Bhullar, Syed Masud, Tamer Okasha, Tanya Lindsay, Teifion Davies, Thomas Gaskarth, Victor Nwokocha, William Kent, Wojciech K Sawicki, Yusuf Gali, Zahid Rahman.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. Bland–Altman Plot demonstrating the degree of agreement between and review of the literature.
Figure 1. Bland–Altman Plot demonstrating the degree of agreement between and review of the literature.
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Figure 2. A radar chart illustrating the degree of perception.
Figure 2. A radar chart illustrating the degree of perception.
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Table 1. The questionnaire outcomes in each respected category, with non-binary data presented at a 95% confidence interval.
Table 1. The questionnaire outcomes in each respected category, with non-binary data presented at a 95% confidence interval.
Years of ExperienceOutcomeWhat Prompts CTA?Outcome
0–428% (95% CI: 22.1–35.5%)Normal ECG9% (95% CI: 5.4–14.5%)
5–1031% (95% CI: 24.8–38.5%)Normal Troponin10% (95% CI: 6.2–15.8%)
>1041% (95% CI: 33.4–47.9%)Raised D-Dimer44% (95% CI: 36.9–51.6%)
Prior Involvement (Yes)96% (n = 166/173)Raised Lactate25% (95% CI: 19.0–31.8%)
Prior Diagnosis None Of the Above35% (95% CI: 28.3–42.2%)
0–449% (95% CI: 41.8–56.5%)All the Above12% (95% CI: 8.0–17.8%)
5–1038% (95% CI: 31.0–45.1%)
>1013% (95% CI: 8.9–18.9%)Rapid CTA & Reporting: (Yes)70% (n = 122/173)
A Differential in Chest Pain? (Yes)94% (n = 163/173)First Line Antihypertensive?
Suspecting Symptoms Labetalol88% (95% CI: 82.2–91.9%)
Severity and Location of Pain75% (95% CI: 67.6–80.5%)GTN19% (95% CI: 13.9–25.6%)
Neurology68% (95% CI: 60.3–74.2%)Nitroprusside1% (95% CI: 0.3–4.1%)
Shortness Of Breath11% (95% CI: 7.1–16.5%)Hydralazine0% (95% CI: 0.0–2.2%)
Nausea And Vomiting6% (95% CI: 3.6–11.0%)I Don’t Start2.5% (95% CI: 0.9–5.8%)
All the Above25% (95% CI: 19.0–31.8%)Site Management
None Of the Above0.5% (95% CI: 0.1–2.5%)Local41% (95% CI: 34.0–48.5%)
Suspecting Clinical Signs Tertiary Centre47% (95% CI: 39.9–54.3%)
Hypertension69% (95% CI: 61.7–75.2%)Both12% (95% CI: 7.8–17.7%)
Pulse Deficit65% (95% CI: 57.7–71.6%)Specialty Management
Focal Neurology72% (95% CI: 64.7–78.1%)Internal Medicine33% (95% CI: 26.4–39.9%)
Reduced Air Entry0.5% (95% CI: 0.1– 2.5%)Vascular Surgery40% (95% CI: 33.4–47.0%)
Murmurs50% (95% CI: 42.6–57.4%)Cardiothoracic Surgery51% (95% CI: 43.6–58.2%)
All the Above20% (95% CI: 14.7–26.6%)Decision Tool Awareness?
Risk Factor? Aortic Dissection Decision Tool26% (95% CI: 20.1–32.9%)
Age48% (95% CI: 40.4–55.7%)ADDR + Age Adjusted D-Dimer19% (95% CI: 13.9–25.6%)
Gender30% (95% CI: 23.8–37.1%)ADDR + D-Dimer > 50019% (95% CI: 13.9–25.6%)
Pregnancy13% (95% CI: 8.9–18.7%)ADDR + Ascending Aorta > 401.5% (95% CI: 0.5–4.3%)
Connective Tissue Disorder56% (95% CI: 48.6–62.8%)None Of the Above51% (95% CI: 43.6–58.2%)
Cardiovascular Risk Factors0% (95% CI: 0.0–2.1%)All the Above0.5% (95% CI: 0.1–2.5%)
Aortic Surgery51% (95% CI: 43.6–58.2%)Is Stratification Useful? (Yes)85% (n = 147/173)
Family History of Aortic Valve Disease31% (95% CI: 24.6–38.3%)Rate Of Misdiagnosis?
All the Above39% (95% CI: 31.7–46.5%)10–29%31% (95% CI: 24.6–38.3%)
In Teaching Programme? (Yes)93% (n = 161/173)30–49%39% (95% CI: 31.7–46.5%)
Is There a SOP (Yes)32% (n = 55/173)>50%30% (95% CI: 23.5–37.3%)
Table 2. Comparison of survey response per category per years of experience.
Table 2. Comparison of survey response per category per years of experience.
Group 1
(0–4 Years)		Group 2
(5–10 Years)		Group 3
(>10 Years)		p-Value
How Many Diagnosed (0–4)67.35%
(95% CI: 54.22–80.48%)		57.41%
(95% CI: 44.22–70.60%)		28.99%
(95% CI: 18.28–39.69%)		p < 0.001
How Many Diagnosed (5–10)26.53%
(95% CI: 14.17–38.89%)		33.33%
(95% CI: 20.76–45.91%)		50.72%
(95% CI: 38.93–62.52%)		p < 0.05
How Many Diagnosed (>10)6.12%
(95% CI: 0.00–12.84%)		9.26%
(95% CI: 1.53–16.99%)		20.29%
(95% CI: 10.80–29.78%)		p < 0.05
Murmurs48.98%
(95% CI: 34.98–62.98%)		37.04%
(95% CI: 24.16–49.92%)		65.22%
(95% CI: 53.98–76.46%)		p < 0.01
Normal ECG as a Prompt4.08%
(95% CI: 0.00–9.62%)		1.85%
(95% CI: 0.00–5.45%)		17.39%
(95% CI: 8.45–26.33%)		p < 0.01
Rapid CT
& Reporting		59.18%
(95% CI: 45.42–72.95%)		64.81%
(95% CI: 52.08–77.55%)		82.61%
(95% CI: 73.67–91.55%)		p < 0.05
First Line Antihypertensive: Labetalol100.00%
(95% CI: 100.00–100.00%)		92.59%
(95% CI: 85.61–99.58%)		86.96%
(95% CI: 79.01–94.90%)		p < 0.05
Table 3. Pooled prevalence analysis at 95% CI.
Table 3. Pooled prevalence analysis at 95% CI.
ESVSOhle
et al. [29]		Von Kodolitsch et al. [28]Riambau
et al. [16].		McLatchie
et al. [30]		Morello
et al. [26]		Rogers
et al. [32]		Nazerian
et al. [27]		Matsushita et al. [31]Suzuki et al. [25]Pooled Analysis
Pain and Location80%81.2%79%83–89%44–86%-72.7–79.3%-44–69%86.3–89.2%76.4% (95% CI: 72.7–79.8%)
Neurology--20%-8%10.2%--6%-11.5% (95% CI: 7.6–17.0%)
Shortness of Breath----------N/A
Nausea/Vomiting----------N/A
Hypertension--82%82.1%31%69.4%-55.4%73%69.1%68.6% (95% CI: 61.5–74.9%)
Pulse Deficit9%5.3%38%-1%14.3%20.3%7.9%-21.1%15.1% (95% CI: 10.6–21.1%
Focal Neurology7%10.8%13%-5%1.41–5.42%10.8%11.4%3%4.7%9.3% (95% CI: 5.8–14.4%)
Reduced Air Entry----------N/A
Murmur-4.2%28%-0.2%2.7%23.6%---14.4% (95% CI: 9.7–20.8%)
AgeYes *68.557665570-627164.664.5 (95% CI: 61–69 years)
PregnancyYes *---3%----0.2%1.6% (95% CI: 1.1–4.3%)
Connective Tissue Disorder13–22%0.2%--0.5%5%4.3%--2.9%8.9% (95% CI: 5.6–14.1%)
Cardiovascular Risk Factors-6%---42.9%--53%42%35.0% (CI: 10.7–59.3%)
Aortic Surgery-0.3%--1%2%2.8%--12.3%4.9% (95% CI: 2.6–9.0%)
Aortic Valve Disease-1.5%--2%14.3%11.9%---6.3% (95% CI: 3.4–11.5%)
Normal ECG---------31%N/A
Normal Troponin----------N/A
Raised D-DimerYes *---40%18.2–77.8%Yes *YES *94–97%Yes *61.8% (95% CI: 54.4–68.7%)
Raised LactateYes *---Yes *-----N/A
% indicates the degree of factor presentation in TBAD; - indicates lack of data; * without percentage N/A indicates meaningful statistical analysis not plausible. Male: 66.5% (44.55% to 88.45%) vs. female: 51.2% (39.1–62.6%).
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Kordzadeh, A.; Rhodes, K.M. Type B Aortic Dissection Management Strategies: National Survey, Systematic Review, and Pooled Clinician Perceptions. J. Vasc. Dis. 2026, 5, 2. https://doi.org/10.3390/jvd5010002

AMA Style

Kordzadeh A, Rhodes KM. Type B Aortic Dissection Management Strategies: National Survey, Systematic Review, and Pooled Clinician Perceptions. Journal of Vascular Diseases. 2026; 5(1):2. https://doi.org/10.3390/jvd5010002

Chicago/Turabian Style

Kordzadeh, Ali, and Karen May Rhodes. 2026. "Type B Aortic Dissection Management Strategies: National Survey, Systematic Review, and Pooled Clinician Perceptions" Journal of Vascular Diseases 5, no. 1: 2. https://doi.org/10.3390/jvd5010002

APA Style

Kordzadeh, A., & Rhodes, K. M. (2026). Type B Aortic Dissection Management Strategies: National Survey, Systematic Review, and Pooled Clinician Perceptions. Journal of Vascular Diseases, 5(1), 2. https://doi.org/10.3390/jvd5010002

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