title: Predictors of aortic growth in uncomplicated type B aortic dissection.
abstract: BACKGROUND
  Patients with uncomplicated acute type B aortic dissection (ABAD) generally can be treated with conservative medical management. However, these patients may develop aortic enlargement during follow-up, with the risk for rupture, which necessitates intervention. Several predictors have been studied in recent years to identify ABAD patients at high risk for aortic enlargement who may benefit from early surgical or endovascular intervention. This study systematically reviewed and summarized the current available literature on prognostic variables related to aortic enlargement during follow-up in uncomplicated ABAD patients.
  
  
  METHODS
  Studies were included if they reported predictors of aortic growth in uncomplicated ABAD patients. Studies about type A aortic dissection, aortic aneurysm, intramural hematoma, or ABAD that required acute intervention were excluded.
  
  
  RESULTS
  A total of 18 full-text articles were selected. The following predictors of aortic growth in ABAD patients were identified: age <60 years, white race, Marfan syndrome, high fibrinogen-fibrin degradation product level (≥20 μg/mL) at admission, aortic diameter ≥40 mm on initial imaging, proximal descending thoracic aorta false lumen (FL) diameter ≥22 mm, elliptic formation of the true lumen, patent FL, partially thrombosed FL, saccular formation of the FL, presence of one entry tear, large entry tear (≥10 mm) located in the proximal part of the dissection, FL located at the inner aortic curvature, fusiform dilated proximal descending aorta, and areas with ulcer-like projections. Tight heart rate control (<60 beats/min), use of calcium-channel blockers, thrombosed FL, two or more entry tears, FL located at the outer aortic curvature, and circular configuration of the true lumen were associated with negative or limited aortic growth.
  
  
  CONCLUSIONS
  Several predictors might be used to identify those ABAD patients at high risk for aortic growth. Although conservative management remains indicated in uncomplicated ABAD, these patients might benefit from closer follow-up or early endovascular intervention.
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Guido H W
authors.initials: GH
authors.lastname: van Bogerijen
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jip L
authors.initials: JL
authors.lastname: Tolenaar
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rampoldi
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Joost A
authors.initials: JA
authors.lastname: van Herwaarden
authors.affiliation: Department of Vascular Surgery, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands.
authors.forename: Frederik H W
authors.initials: FH
authors.lastname: Jonker
authors.affiliation: University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy. Electronic address: santi.trimarchi@unimi.it.
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D001011:Aorta / Q000473:pathology*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D001027:Aortography; D018450:Disease Progression; D006801:Humans; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome