Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
J Thorac Cardiovasc Surg. 2015 Feb;149(2 Suppl):S163-7. doi: 10.1016/j.jtcvs.2014.11.028. Epub 2014 Nov 20.
An aging population, increased awareness, high-resolution imaging, and improving access to care all mean that more people are being diagnosed with acute aortic dissection. A better understanding of the role of initial medical therapy, improved surgical techniques, and the addition of endovascular approaches to the treatment algorithm, have resulted in more patients surviving the acute phase of disease. During the chronic phase, patients with residual dissection are challenged by the competing risks of reoperation or death. Open repair for chronic type-B dissection can be performed safely but is a relatively morbid operation. For this reason, surgery is often postponed until patients develop very late complications. Despite encouraging results for thoracic endovascular aortic repair of acute type-B dissection, chronic type-B dissection poses unique challenges that make application of endovascular technology more difficult. As our understanding of the disease and its natural history evolves, the ways in which these 2 methods of treatment complement each other need to be better understood. The benefits and limitations of each therapy, and how and when to apply each in the setting of chronic distal dissection, are discussed.
人口老龄化、意识提高、高分辨率成像以及更好的医疗服务可及性，意味着越来越多的人被诊断出患有急性主动脉夹层。对初始药物治疗作用的认识不断加深，外科技术的进步，以及血管内治疗方法在治疗方案中的加入，使得更多的患者能够在疾病的急性期存活下来。在慢性期，仍有夹层的患者面临着再次手术或死亡的风险。慢性 B 型夹层的开放修复可以安全进行，但手术相对较为复杂。因此，手术通常会推迟到患者出现非常晚期的并发症。尽管急性 B 型夹层的胸主动脉腔内修复术取得了令人鼓舞的结果，但慢性 B 型夹层存在独特的挑战，使得血管内技术的应用更加困难。随着我们对疾病及其自然史认识的不断发展，需要更好地理解这两种治疗方法的互补性。本文讨论了每种治疗方法的优缺点，以及如何在慢性远端夹层的情况下何时应用每种治疗方法。
