Gorton Andrew J, Keshavamurthy Suresh, Saha Sibu P
Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky.
Int J Angiol. 2024 May 30;33(4):237-249. doi: 10.1055/s-0044-1787304. eCollection 2024 Dec.
The thoracic aorta is a dynamic structure composed of the aortic root, ascending aorta, aortic arch, and descending aorta. It is subject to the pressure and volume of the cardiac cycle and susceptible to atherosclerotic and aneurysmal changes. With these changes, the risk for acute aortic syndromes increases, thus creating the impetus for earlier interventions. The previous standard of open surgical repair has undergone a transition in recent years toward endovascular repair being favored in the descending and abdominal aortas with ongoing investigation into approaches for the ascending and aortic arch. These therapies have been shown to improve early mortality and morbidity outcomes with the caveat of more interventions compared with open surgery. We undertook this review to analyze the current data available regarding long-term outcomes in patients undergoing endovascular repair for thoracic aortic disease. The data support long-term benefit of endovascular repair for thoracic aortic disease. The primary indications identified for reintervention are endoleak and further aneurysmal degeneration. As the devices available for endovascular repair evolve, ongoing review of these outcomes will be necessary. It will also be important to trend the results as further techniques become available for endovascular repair of the ascending aorta and aortic arch.
胸主动脉是一个动态结构，由主动脉根部、升主动脉、主动脉弓和降主动脉组成。它受到心动周期的压力和容量影响，易发生动脉粥样硬化和动脉瘤样改变。随着这些变化，急性主动脉综合征的风险增加，从而推动了早期干预。过去的开放手术修复标准近年来已发生转变，在降主动脉和腹主动脉中，血管内修复更受青睐，同时正在对升主动脉和主动脉弓的治疗方法进行研究。与开放手术相比，这些治疗方法已被证明可改善早期死亡率和发病率，但需要更多的干预措施。我们进行这项综述是为了分析目前关于胸主动脉疾病血管内修复患者长期预后的可用数据。数据支持胸主动脉疾病血管内修复的长期益处。再次干预的主要指征是内漏和进一步的动脉瘤样退变。随着可用于血管内修复的器械不断发展，有必要持续评估这些预后。随着更多技术可用于升主动脉和主动脉弓的血管内修复，对结果进行跟踪也将很重要。
