Preventza Ourania, Le Huu Alice, Olive Jackie, Cekmecelioglu Davut, Coselli Joseph S
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.
Ann Cardiothorac Surg. 2022 Jan;11(1):26-30. doi: 10.21037/acs-2021-taes-71.
Different pathologies of the ascending aorta (AA), including aneurysms, acute and chronic dissections, and pseudoaneurysms, have been treated with open surgical repair with very good results, especially at aortic centers of excellence. There is, however, a subset of patients for whom open surgery is considered to pose high or prohibitive risk. These patients can benefit from a less invasive approach with catheters and wires, percutaneous techniques and stent grafts. However, the existing technology was developed to treat descending thoracic aortic pathologies; it is not approved for use in the AA by the US Food and Drug Administration (FDA). The devices used for the descending thoracic aorta (DTA) have certain size and design limitations that make their application to the AA cumbersome at times. As a result, custom-made endografts have been used to treat pathologies in the AA, although their use is feasible only in elective procedures. In addition, the AA has specific anatomic and physiologic characteristics that raise concerns about the long-term durability of the current technology. In this review, we outline the limitations, challenges and current status of endovascular technology to treat pathologies of the AA.
升主动脉（AA）的不同病变，包括动脉瘤、急慢性夹层和假性动脉瘤，已通过开放手术修复进行治疗，效果非常好，尤其是在主动脉疾病治疗水平卓越的中心。然而，有一部分患者被认为进行开放手术的风险很高或过高。这些患者可以从使用导管和导丝、经皮技术和支架移植物的侵入性较小的方法中受益。然而，现有技术是为治疗胸降主动脉病变而开发的；美国食品药品监督管理局（FDA）未批准其用于升主动脉。用于胸降主动脉（DTA）的装置有一定的尺寸和设计限制，这使得它们有时难以应用于升主动脉。因此，定制的腔内移植物已被用于治疗升主动脉病变，尽管其仅在择期手术中可行。此外，升主动脉具有特定的解剖和生理特征，这引发了人们对当前技术长期耐用性的担忧。在这篇综述中，我们概述了治疗升主动脉病变的血管内技术的局限性、挑战和现状。
