Dudzinski David M, Isselbacher Eric M
Thoracic Aortic Center, Massachusetts General Hospital, Yawkey 5, Boston, MA, 02114, USA.
Curr Cardiol Rep. 2015 Dec;17(12):106. doi: 10.1007/s11886-015-0655-z.
Thoracic aortic aneurysms are typically asymptomatic and discovered incidentally on an imaging study ordered for other indications. Small aneurysms are managed with antihypertensive therapy and surveillance imaging, using either echocardiography, computed tomographic angiography (CTA), or magnetic resonance angiography (MRA). Aneurysms are repaired when the risk of rupture or dissection exceeds the risk of repair; size thresholds for repair are determined by the underlying etiology of the aneurysm, with lower thresholds for those with genetic aortopathies. In contrast to the silent and asymptomatic nature of aneurysms, acute aortic syndromes-which include aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer-are usually associated with recognizable symptoms and signs. Acute aortic syndromes involving the ascending aorta are treated with emergent surgery, whereas those involving the descending aorta are now often treated with endovascular stent-grafting techniques. After acute aortic syndromes have been successfully treated, prognosis is favorable with close follow-up that includes optimal medical management and regular surveillance imaging.
胸主动脉瘤通常无症状，在因其他指征进行的影像学检查中偶然发现。小动脉瘤采用抗高血压治疗和监测成像进行管理，可使用超声心动图、计算机断层血管造影（CTA）或磁共振血管造影（MRA）。当破裂或夹层风险超过修复风险时，对动脉瘤进行修复；修复的大小阈值由动脉瘤的潜在病因决定，对于患有遗传性主动脉病变的患者，阈值较低。与动脉瘤的隐匿和无症状性质相反，急性主动脉综合征——包括主动脉夹层、壁内血肿和穿透性动脉粥样硬化溃疡——通常伴有可识别的症状和体征。累及升主动脉的急性主动脉综合征采用急诊手术治疗，而累及降主动脉的急性主动脉综合征现在通常采用血管内支架植入技术治疗。急性主动脉综合征成功治疗后，通过密切随访，包括优化的药物治疗和定期监测成像，预后良好。
