title: Discordance of aortic remodeling with clinical outcomes in patients treated with endovascular repair for uncomplicated type B aortic dissection.
abstract: Uncomplicated type B aortic dissection is managed with anti-impulse therapy since surgery offers no additional long-term survival advantage. In recent years, thoracic endovascular repair (TEVAR) has been forwarded as a treatment strategy that may retard aortic growth, lower rupture risk, and improve clinical outcome compared to medical management in patients with uncomplicated type B aortic dissection. Although aortic remodeling often serves as a surrogate measure of treatment success in trials of aortic dissection, there is, in fact, little evidence to suggest that aortic remodeling confers a clinical advantage in this patient cohort. TEVAR likely will not be widely recommended for the patient with uncomplicated type B aortic dissection until a prospective comparative clinical trial demonstrates a clear clinical advantage of TEVAR over medical management. Measures of aortic remodeling are poor surrogate measures of treatment success in this patient population.
authors.affiliation: Miller Scientific Consulting, Inc., Biltmore Lake, NC 28715, USA. lmiller@millerscinc.com
authors.forename: Larry E
authors.initials: LE
authors.lastname: Miller
authors.forename: Lee M
authors.initials: LM
authors.lastname: Pierson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017546:Angioscopy / Q000379:methods*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology*; D055815:Young Adult