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Published on: March 26, 2018
Interventional treatment strategies of thoracic aortic pathologies
1Department of Internal Medicine I, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany. ibrahim.akin@umm.de.
Insights
New endovascular techniques offer promising primary treatments for descending aortic diseases, while hybrid approaches address aortic arch pathologies. Multidisciplinary teams are crucial for individualized thoracic aortic disease management.
Area of Science:
- Vascular Surgery
- Cardiology
- Radiology
Background:
- Thoracic aortic diseases, including aortic dissection and aneurysm, are increasingly prevalent due to aging populations and advanced imaging.
- Current management for ascending aorta and proximal arch pathologies relies on traditional surgical methods.
Purpose of the Study:
- To review emerging endovascular and hybrid strategies for thoracic aortic diseases.
- To highlight the importance of a multidisciplinary approach in managing complex aortic conditions.
Main Methods:
- Review of current literature on endovascular and hybrid treatments for thoracic aortic pathologies.
- Discussion of the evolution of treatment strategies for aortic dissection and aneurysm.
Main Results:
- Endovascular approaches are becoming primary treatments for descending aortic pathology in suitable patients.
- Hybrid procedures combining surgery and stent-grafts are emerging for aortic arch pathologies, potentially reducing risks associated with open repair.
- Classical surgical strategies remain dominant for ascending aorta and proximal arch issues.
Conclusions:
- Endovascular and hybrid techniques represent significant advancements in treating thoracic aortic diseases, particularly for descending aorta and arch pathologies.
- Individualized treatment strategies, developed by multidisciplinary teams (cardiologists, cardiac surgeons, anesthesiologists, radiologists), are essential for optimal patient outcomes.
- Treatment should be conducted in centers with expertise in both endovascular and surgical procedures.
Abstract:
Chronic and acute diseases of the thoracic aorta, including aortic dissection and aortic aneurysm are attracting increasing attention both in the light of an ageing Western and Oriental population and with the proliferation of modern diagnostic imaging modalities. While classical surgical strategies still dominate the care for acute and chronic pathology of the ascending aorta and the proximal arch region, new endovascular concepts are emerging and are likely to evolve as primary treatment strategies for descending aortic pathology in suitable patients constituting the majority of cases. Additionally, aortic arch pathologies are becoming the target of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in the attempt to improve outcome by avoiding the high risk of open arch repair or complete replacement. Nonetheless, due to the complexity of the underlying vascular disease, every patient should be discussed in a team consisting of cardiologists, cardiac surgeons, anaesthesiologists and radiologists and an individualized therapeutic strategy should be carried out in a center with experience in both endovascular and surgical procedures.
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