Endoluminal thoracic aortic repair: does the parachute need to be randomized?

Development of endoluminal repair has substantially reduced mortality and morbidity associated with repair of the thoracic aorta. It has significant advantages over conventional surgical repair, particularly in the management of acute dissection and thoracic aortic injury. Despite these perceived advantages it is important to realize that no level 1 data are available to prove safety and/or efficacy. Because the advantages are perceived to be so great these data are unable to be accrued and it is important that clinicians involved with this procedure keep rigorous data and undertake ongoing evaluation to ensure that clinical perceptions are eventually underpinned by robust data.