Department of Emergency Medicine, George Washington University Hospital, 2000 N Street NW, Apartment P3, Washington, DC 20036.
Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI.
Semin Vasc Surg. 2022 Mar;35(1):16-34. doi: 10.1053/j.semvascsurg.2022.02.007. Epub 2022 Feb 18.
Thoracic aortic aneurysm and dissection are complex diagnoses that require management by multidisciplinary providers using a variety of medical therapies, surgical interventions, and lifestyle modifications. Pharmacological agents, such as β-blockers (atenolol) and angiotensin II type 1 receptor blockers (losartan), have been mainstay treatments for several years, and research from the past decade has continued to evaluate these and other medication classes to further improve patient morbidity and mortality. Combination β- and renin-aldosterone-angiotensin blockade, statins, metformin, antioxidants, and vitamins have been evaluated as therapeutics in both thoracic and abdominal aortic aneurysms, as well as the effects of various antibiotics (ie, fluoroquinolones and tetracyclines) and benefits of lifestyle modifications (eg, diet and exercise) and enhanced patient-centered care and treatment adherence. In addition, as our understanding of the genetic, biochemical, and pathophysiological mechanisms behind these diseases expands, so do potential targets for future therapeutic research (eg, interleukins, matrix metalloproteases, and mast cells). This review incorporates the major meta-analyses, systematic and generalized reviews, and clinical trials published from 2010 through 2021 that focus on these topics in thoracic aortic aneurysms (and abdominal aneurysms when thoracic literature is scarce). Several key ongoing clinical trials, case studies, and in vivo/in vitro studies are also mentioned. Furthermore, we discuss current gaps in the literature and the abundance of clinical evidence for some interventions in abdominal aneurysms with few thoracic correlates, thus indicating a need for investigation of these subjects in the latter.
胸主动脉瘤和夹层是复杂的诊断，需要多学科提供者使用多种医学治疗、手术干预和生活方式改变来进行管理。多年来，药理学药物（如β受体阻滞剂（阿替洛尔）和血管紧张素 II 型 1 型受体阻滞剂（氯沙坦））一直是主要治疗方法，过去十年的研究继续评估这些和其他药物类别，以进一步提高患者的发病率和死亡率。联合β受体和肾素-血管紧张素-醛固酮阻断剂、他汀类药物、二甲双胍、抗氧化剂和维生素已被评估为胸主动脉瘤和腹主动脉瘤的治疗方法，以及各种抗生素（如氟喹诺酮类和四环素类）的作用和生活方式改变（如饮食和运动）的益处以及增强以患者为中心的护理和治疗依从性。此外，随着我们对这些疾病背后的遗传、生化和病理生理机制的理解的扩展，未来治疗研究的潜在靶点也在增加（例如，白细胞介素、基质金属蛋白酶和肥大细胞）。本综述纳入了 2010 年至 2021 年期间发表的主要荟萃分析、系统和综合评价以及临床试验，这些研究集中在胸主动脉瘤（当胸主动脉瘤文献稀少时，也包括腹主动脉瘤）的这些主题上。还提到了一些正在进行的关键临床试验、案例研究和体内/体外研究。此外，我们还讨论了目前文献中的空白以及一些干预措施在腹主动脉瘤中的大量临床证据，而胸主动脉瘤相关证据很少，因此表明需要对后者进行这些主题的研究。
