title: Uncomplicated type B dissections: which patients should be treated? Lessons learned from the recent literature.
abstract: The management of type B aortic dissection is complex and decision-making is often based on physician experience and subjective clinical judgment. Thoracic endovascular aortic repair is considered first-line therapy for complicated type B aortic dissection but whether this should be performed in uncomplicated cases has been a matter of debate. Randomized controlled trials have demonstrated the long-term benefit of endovascular treatment to prevent aortic-related mortality, however pre-emptive surgery may not be the solution for all patients because of the occurrence of adverse events such death, stroke and paraplegia. Morphological and false lumen characteristics including aortic diameter, the position, size and number of entry tears and false lumen thrombus volume have been shown to serve as predictors of outcome and may be used to identify high-risk patients. Functional imaging methods such as magnetic resonance and echocardiography are evolving and may be able to provide the clinically-relevant structural, hemodynamic and biomechanical information that is needed for accurate risk stratification of individual patients. A patient-specific approach designed to intervene only in patients that are at high risk of developing complications should improve the long-term outcome of these patients.
authors.affiliation: Department of Vascular Surgery NIHR Comprehensive Biomedical Research Centre of Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK - rachel.clough@kcl.ac.uk.
authors.forename: R E
authors.initials: RE
authors.lastname: Clough
authors.forename: M A
authors.initials: MA
authors.lastname: Albayati
authors.forename: T
authors.initials: T
authors.lastname: Donati
authors.forename: P R
authors.initials: PR
authors.lastname: Taylor
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D003661:Decision Support Techniques; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents