Aortic Institute at Yale-New Haven Hospital, New Haven, Conn., USA.
J Vasc Surg. 2012 Aug;56(2):565-71. doi: 10.1016/j.jvs.2012.04.053.
Understanding the natural history of thoracic aortic aneurysms (TAAs) is essential to patient care and surgical decision making. In this evidence summary we discuss some of the most clinically relevant features of the disease. The true incidence of TAAs is likely to be higher than currently reported because of the inherently silent nature of TAAs. However, TAAs can become rapidly lethal once dissection or rupture occurs, highlighting the need for more robust screening. The impressive discovery of familial patterns and novel genetic loci for TAAs challenges the idea that most TAAs are simply sporadic. Although the aorta grows in an indolent manner, its rate of growth and its current diameter both have important clinical implications. Biomechanical studies have supported clinical findings of 6.0 cm as a dangerous threshold. Surgical extirpation of TAAs is currently the mainstay of effective treatment. Although endovascular TAA repair is becoming increasingly common, long-term safety remains unproven. We still need more data to support the concept that any medical therapy is effective.
了解胸主动脉瘤（TAAs）的自然病史对于患者的治疗和手术决策至关重要。在本证据总结中，我们讨论了该疾病一些最具临床相关性的特征。由于 TAAs 本质上是无声的，因此其实际发病率可能高于目前的报告。然而，一旦发生夹层或破裂，TAAs 可能会迅速致命，这凸显了更有力的筛查的必要性。家族模式和新的 TAAs 遗传位点的惊人发现，挑战了大多数 TAAs 只是散发性的观点。尽管主动脉以一种惰性的方式生长，但它的生长速度及其当前直径都具有重要的临床意义。生物力学研究支持了 6.0 厘米作为危险阈值的临床发现。目前，外科切除 TAA 仍然是有效治疗的主要手段。尽管血管内 TAA 修复越来越常见，但长期安全性仍未得到证实。我们仍然需要更多的数据来支持任何药物治疗都有效的概念。
