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Management of Ascending Aorta and Aortic Arch: Similarities and Differences Among Cardiovascular Guidelines

Konstantinos Spanos1,2, Petroula Nana1, Yskert von Kodolitsch2

  • 1Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists
|December 7, 2021
PubMed

Insights

Current cardiovascular guidelines show inconsistencies in managing ascending aorta and aortic arch diseases. More research is needed to establish clear recommendations, especially regarding endovascular techniques for these aortic conditions.

Area of Science:

  • Cardiovascular Medicine
  • Thoracic Surgery
  • Medical Guidelines

Background:

  • Ascending aorta and aortic arch diseases are of growing interest to cardiovascular specialists.
  • Innovations in endovascular and open surgery have expanded treatment options for complex aortic conditions.
  • This review analyzes current cardiovascular guidelines for ascending aorta and aortic arch diseases.

Purpose of the Study:

  • To systematically review and analyze current cardiovascular guidelines.
  • To identify overlaps and differences in recommendations for ascending aorta and aortic arch diseases.
  • To assess the evidence base supporting guideline recommendations.

Main Methods:

  • Systematic literature search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (January 2009-December 2020).
  • Analysis of recommendations on definitions, diagnosis, indications for treatment, and management of ascending aorta and aortic arch diseases.
  • Inclusion of 5 multidisciplinary cardiovascular society guidelines published between 2010 and 2019.

Main Results:

  • Lack of a clear definition for non-A-non-B aortic dissection in most guidelines.
  • Disagreement on recommendation class and evidence level for ascending aorta diameter as an indication for treatment.
  • Limited evidence and inconsistent recommendations for endovascular techniques and aortic arch disease management.

Conclusions:

  • Current guidelines predominantly favor open surgery for ascending aorta and aortic arch diseases.
  • Recommendations are largely based on expert opinion, with limited integration of endovascular techniques.
  • Heterogeneity, inconsistency in evidence levels, and a need for more robust data are evident.
Abstract

Keywords:
aortic arch aneurysmaortic arch dissectionascending aortaendovascular treatment/therapyguidelines

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