Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
Semin Thorac Cardiovasc Surg. 2019;31(4):697-702. doi: 10.1053/j.semtcvs.2019.03.011. Epub 2019 Apr 11.
The management of the aortic arch aneurysm is becoming increasingly complex and multidisciplinary. It has evolved since the first successful repair by DeBakey et al in 1957. After these initial repairs, the improvement in open surgical techniques, cardiopulmonary bypass, anesthesia, and perioperative care were the primary drivers of the decrease in morbidity and mortality associated with repair. The development of endovascular technology has spurred another revolution in the management of aortic arch aneurysms. In this review, we present a current appraisal and description of open surgical, hybrid, and endovascular techniques based on the literature. These techniques are varied and have different advantages and disadvantages, depending on patient anatomy and perioperative surgical risk. We provide an overview of the attributes of each technique and how they may be applied to individual cases. While each technique could not be discussed in detail in this report, it is clear that institutions must be able to proficiently offer the full spectrum of open, hybrid, and endovascular surgical techniques to treat this diverse condition. For low and intermediate risk patients, open surgery remains the gold standard. However, just as improvements in technique, monitoring and perioperative care led to progress in open repair, similar advancements in endograft technology, anatomical customization, and embolic protection will expand the use of endovascular repair. As the management of the condition becomes increasingly nuanced and multidisciplinary, centers must be equipped to offer a variety of techniques with high fidelity and adaptability to each unique patient.
升主动脉瘤的治疗变得越来越复杂和多学科化。自 1957 年 DeBakey 等人首次成功修复以来，它已经发展起来。在这些初始修复之后，开放手术技术、体外循环、麻醉和围手术期护理的改进是与修复相关的发病率和死亡率降低的主要驱动因素。血管内技术的发展又引发了升主动脉瘤治疗的另一场革命。在这篇综述中，我们根据文献对开放手术、杂交和血管内技术进行了当前评估和描述。这些技术各不相同，根据患者的解剖结构和围手术期手术风险，具有不同的优缺点。我们提供了每种技术的属性概述以及如何将其应用于个别病例。虽然每种技术在本报告中都无法详细讨论，但很明显，各机构必须能够熟练地提供开放、杂交和血管内手术技术的全部范围，以治疗这种多样化的疾病。对于低风险和中风险患者，开放手术仍然是金标准。然而，正如技术的改进、监测和围手术期护理推动了开放修复的进展一样，移植物技术、解剖定制和栓塞保护的类似进步将扩大血管内修复的应用。随着疾病的治疗变得越来越复杂和多学科化，中心必须具备提供各种技术的能力，这些技术具有高度保真度和适应性，可以满足每个独特患者的需求。
