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Descending thoracic aortic emergencies: Past, present, and future.
Mohammed Habib1, David Lindström1, Jacob Budtz Lilly2
1Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, 75185, Sweden.
Seminars in Vascular Surgery
|June 17, 2023
Summary
Management of descending thoracic aortic (DTA) pathologies like aneurysms and dissections is improving, but challenges remain. Advances in imaging and endovascular repair offer new hope, yet robust evidence is still needed.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Medical Imaging
Background:
- Descending thoracic aortic (DTA) pathologies, including aneurysms, dissections, and trauma, pose significant risks of bleeding and ischemia.
- Despite advances in medical therapy and endovascular techniques, morbidity and mortality rates for DTA pathologies remain high.
- Differentiating DTA pathologies from cardiac diseases presents a diagnostic challenge, with ongoing efforts to develop specific blood tests.
Purpose of the Study:
- To provide a narrative review of the evolving management strategies for DTA pathologies.
- To discuss current challenges in diagnosis and treatment.
- To explore future perspectives in the field.
Main Methods:
- Review of current literature on DTA pathology management.
- Discussion of diagnostic modalities, particularly computed tomography (CT) and emerging blood tests.
- Analysis of treatment transitions from open repair to endovascular repair with stent-grafts.
Main Results:
- Significant advancements in imaging modalities over the past two decades have improved understanding and treatment of DTA pathologies.
- Computed tomography is the primary diagnostic tool for thoracic aortic emergencies.
- Medical management, including intensive care, blood pressure control, and permissive hypotension, is crucial for initial stability.
- Surgical management has shifted towards endovascular repair, with substantial improvements in both open and endovascular techniques.
Conclusions:
- While understanding and treatment options for DTA pathologies have advanced, robust evidence from prospective studies is still lacking.
- Continued research is needed to refine diagnostic tools and treatment protocols.
- Multidisciplinary approaches combining medical and surgical interventions are essential for optimal patient outcomes.
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