From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Circ Res. 2019 Feb 15;124(4):647-661. doi: 10.1161/CIRCRESAHA.118.313186.
Aneurysmal disease can affect any segment of the aorta, from the aortic root to the aortic bifurcation. The treatment of aortic aneurysms has evolved dramatically in the past 3 decades, with the introduction of endovascular aneurysm repair using stent grafts causing a major paradigm shift in the field of aortic aneurysm surgery. While the technical details of the management of aortic aneurysms vary greatly depending on the location of an aneurysm, the principles remain the same. Successful aortic aneurysm treatment depends on either open replacement or endovascular exclusion of the aneurysmal segment with healthy artery proximal and distal to the repair. Major aortic branches of the arch and visceral segment add additional technical complexity to aneurysms involving these regions. Even as endovascular repair becomes the primary treatment modality for most aortic aneurysms, open repair remains an essential treatment modality in many circumstances. Additionally, long-term results of endovascular repair suggest that younger patients with long life expectancy and low-perioperative risk may benefit more from open repair. Therefore, technical expertise in both endovascular and open treatment is necessary for a comprehensive aortic aneurysm surgery practice.
动脉瘤性疾病可影响主动脉的任何节段，从主动脉根部至主动脉分叉处。在过去的 30 年中，主动脉瘤的治疗发生了巨大的变化，使用支架移植物的腔内修复术在主动脉瘤手术领域引起了重大的范式转变。尽管主动脉瘤的管理技术细节因动脉瘤的位置而异，但原则保持不变。成功的主动脉瘤治疗取决于用健康的动脉近端和远端来开放置换或腔内排除动脉瘤段。弓和内脏段的主要主动脉分支为涉及这些区域的动脉瘤增加了额外的技术复杂性。即使腔内修复成为大多数主动脉瘤的主要治疗方式，在许多情况下，开放修复仍然是一种必要的治疗方式。此外，腔内修复的长期结果表明，具有长预期寿命和低围手术期风险的年轻患者可能从开放修复中获益更多。因此，对于全面的主动脉瘤手术实践，需要具备腔内和开放治疗的技术专长。
