King R Wilson, Bonaca Marc P
CPC Clinical Research, 2115 N. Scranton St., Suite 2040 Aurora, CO, USA.
Department of Surgery, University of Colorado, Aurora, CO, USA.
Eur Heart J Acute Cardiovasc Care. 2021 Dec 18;10(10):1197-1203. doi: 10.1093/ehjacc/zuab106.
Acute aortic syndromes represent a spectrum of life-threatening aortic pathologies. Prompt diagnosis and proper management of these syndromes are important in reducing overall mortality and morbidity, which remains high. Acute aortic dissections represent most of these aortic wall pathologies, but intramural haematomas and penetrating atherosclerotic ulcers have been increasingly diagnosed. Type A dissections require prompt surgical treatment, with endovascular options on the horizon. Type B dissections can be complicated or uncomplicated, and treatment is determined based on this designation. Complicated Type B dissections require prompt repair with thoracic endovascular aortic repair (TEVAR) becoming the preferred method. Uncomplicated Type B dissections require medical management, but early TEVAR in the subacute setting is becoming more prominent. Proper surveillance for an uncomplicated Type B dissection is crucial in detecting aortic degeneration and need for intervention. Intramural haematomas and penetrating atherosclerotic ulcers are managed similarly to aortic dissections, but more research is needed to determine the proper management algorithms. Multi-disciplinary aortic programmes have been shown to improve patient outcomes and are necessary in optimizing long-term follow-up.
急性主动脉综合征代表一系列危及生命的主动脉病变。对这些综合征进行及时诊断和恰当处理对于降低总体死亡率和发病率至关重要，而目前死亡率和发病率仍然很高。急性主动脉夹层占这些主动脉壁病变的大部分，但壁内血肿和穿透性动脉粥样硬化溃疡的诊断也越来越多。A型夹层需要及时进行手术治疗，同时血管腔内治疗方案也即将出现。B型夹层可能是复杂型或非复杂型，治疗方案根据该分类来确定。复杂型B型夹层需要及时修复，胸主动脉腔内修复术（TEVAR）正成为首选方法。非复杂型B型夹层需要药物治疗，但在亚急性期早期进行TEVAR正变得越来越普遍。对非复杂型B型夹层进行恰当监测对于检测主动脉退变和确定是否需要干预至关重要。壁内血肿和穿透性动脉粥样硬化溃疡的处理与主动脉夹层类似，但需要更多研究来确定恰当的处理方案。多学科主动脉诊疗项目已被证明可改善患者预后，对于优化长期随访是必要的。
