Linardi Daniele, Gardellini Jacopo, Boschetti Vincenzo, Di Nicola Venanzio, Denora Mariateresa, Puntel Gino, Puppini Giovanni, Luciani Giovanni B
Cardiac Surgery Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy.
Radiology Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy.
J Clin Med. 2024 Aug 23;13(17):4975. doi: 10.3390/jcm13174975.
The treatment of complex aortic pathologies requires specialized techniques and tailored approaches due to each patient's unique anatomical and clinical challenges. The European Association for Cardiothoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) new guidelines identify the aorta as the body's 24th organ and reiterate that multidisciplinary aortic teams are recommended for shared decision-making to determine optimal treatment strategies. Patients treated for conditions such as aneurysms, dissections, intramural hematomas, or penetrating aortic ulcers may develop complex forms over time, necessitating careful follow-up and timely corrective actions. Endovascular solutions can be favorable for older patients with complex anatomies and multiple comorbidities. However, when endovascular treatment is not feasible, hybrid treatments or open surgery must be considered if the patient's condition allows it. The risk-benefit ratio of each procedure must be carefully evaluated; choosing the best intervention or deciding not to intervene becomes a critical and challenging decision. At our Cardiac Surgery Center in Verona, a multidisciplinary team with over 20 years of experience in treating complex aortic arch pathologies extensively discussed different cases of complex aortic pathologies treated with endovascular, hybrid, or surgical approaches, emphasizing the importance of considering both anatomical and patient-specific characteristics. The decisions and treatments were often challenging, and unanimity was not always achieved, reflecting the complexity of finding the best solutions.
由于每个患者独特的解剖结构和临床挑战，复杂主动脉病变的治疗需要专门技术和量身定制的方法。欧洲心胸外科学会（EACTS）和胸外科医师协会（STS）的新指南将主动脉确定为人体的第24个器官，并重申建议多学科主动脉团队共同决策，以确定最佳治疗策略。接受动脉瘤、夹层、壁内血肿或穿透性主动脉溃疡等疾病治疗的患者，随着时间推移可能会发展为复杂形式，需要仔细随访和及时采取纠正措施。血管内治疗方案对解剖结构复杂且合并多种疾病的老年患者可能有利。然而，当血管内治疗不可行时，如果患者情况允许，必须考虑杂交治疗或开放手术。必须仔细评估每种手术的风险效益比；选择最佳干预措施或决定不干预成为一个关键且具有挑战性的决定。在我们位于维罗纳的心脏外科中心，一个在治疗复杂主动脉弓病变方面拥有20多年经验的多学科团队广泛讨论了采用血管内、杂交或手术方法治疗的不同复杂主动脉病变病例，强调了考虑解剖结构和患者特定特征的重要性。这些决策和治疗往往具有挑战性，并非总能达成一致意见，这反映了找到最佳解决方案的复杂性。
