Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwig's University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwig's University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Semin Vasc Surg. 2023 Jun;36(2):150-156. doi: 10.1053/j.semvascsurg.2023.04.016. Epub 2023 Apr 30.
Thoracic aortic emergencies involving the aortic arch are potentially fatal conditions that require the entire surgical repertoire of conventional surgery, such as complete aortic arch replacement using the frozen-elephant-trunk technique, through hybrid procedures, to full surgical endovascular options with conventional or delivered/fenestrated stent-grafts. An interdisciplinary aortic team should choose the optimal treatment of the pathologies of the aortic arch, considering the morphology of the entire aorta, from the root to beyond the bifurcation, as well as the clinical comorbidities. The treatment goal is a complication-free postoperative result and lasting freedom from aortic reinterventions. Irrespective of the selected therapy method, patients should then be connected to a specialized aortic outpatient clinic. The aim of this review was to provide an overview of pathophysiology and current treatment options in emergencies of the thoracic aorta, also involving the aortic arch. We wanted to summarize the preoperative considerations, intraoperative settings, and strategies, as well the postoperative follow-up.
涉及主动脉弓的胸主动脉急症是潜在的致命情况，需要传统手术的全部手术手段，如使用冷冻象鼻技术进行全主动脉弓置换术、杂交手术，以及常规或输送/开窗支架移植物的全主动脉腔内手术选择。一个多学科的主动脉团队应该根据整个主动脉的形态，从根部到分叉以外，以及临床合并症，选择主动脉弓病变的最佳治疗方法。治疗目标是术后无并发症和免于再次主动脉介入治疗。无论选择何种治疗方法，患者都应随后转入专门的主动脉门诊。本综述的目的是概述胸主动脉急症（也涉及主动脉弓）的病理生理学和当前的治疗选择。我们想总结术前考虑、术中设置和策略，以及术后随访。
