Epidemiología, diagnóstico, clasificación e indicaciones quirúrgicas actuales de los aneurismas de la aorta toracoabdominal

IF 0.3 Q4 SURGERY
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Abstract

Thoracoabdominal aortic aneurysms remain a challenge in cardiovascular surgery due to the complexity of the pathology, the invasiveness of surgical treatment required and common patient comorbidities. The prevalence, true and detected, of these aneurysms has increased due to increased life expectancy, improved diagnosis, and greater physician and patient awareness. They can trigger dissection or rupture, and half of all deaths are due to aortic rupture, even in aneurysms with diameters under 6 cm. The goal of treatment is to reduce the risk of adverse aortic events, such as dissection, rupture, or aortic-related death. The timing of intervention requires careful evaluation of anatomic and risk factors for future events versus operative risks. Open surgery aims to replace the aneurysmal thoracoabdominal aortic segment with a prosthetic graft anastomosed to adjacent non-aneurysmal aortic tissues, whereas endovascular repair uses stent-grafts to exclude blood flow from the aneurysmal sac. The morbidity and mortality of open surgical repair are high, especially in patients with comorbidities, and include spinal cord ischemia and renal damage. Endovascular treatment has been developed as a less invasive alternative to open surgery, with promising results in reducing hospital mortality, but its use remains experimental. The choice of treatment requires a multidisciplinary assessment of the patient's risk factors and the anatomical characteristics of the aneurysm. Hybrid treatment, combining thoracic endovascular repair with (simultaneous or deferred) open abdominal surgery, has recently been proposed, but there is still limited experience and no robust evidence for improved outcomes.
胸腹主动脉瘤的流行病学、诊断、分类和当前手术适应症
胸腹主动脉瘤因其病理复杂性、所需手术治疗的侵袭性和患者常见的合并症,仍然是心血管外科的一项挑战。由于预期寿命的延长、诊断水平的提高以及医生和患者意识的增强,这些动脉瘤的真实发病率和检出率都有所上升。这些动脉瘤可能引发夹层或破裂,即使是直径小于 6 厘米的动脉瘤,也有一半的死亡原因是主动脉破裂。治疗的目的是降低主动脉不良事件的风险,如夹层、破裂或与主动脉相关的死亡。介入治疗的时机需要仔细评估解剖因素和未来事件的风险因素与手术风险。开放手术旨在用与邻近的非动脉瘤主动脉组织吻合的人工移植物取代动脉瘤胸腹主动脉段,而血管内修复术则使用支架移植物排除动脉瘤囊的血流。开放性手术修复的发病率和死亡率都很高,尤其是在有合并症的患者中,包括脊髓缺血和肾脏损伤。血管内治疗作为开放手术的微创替代疗法已经得到开发,在降低住院死亡率方面取得了可喜的成果,但其应用仍处于试验阶段。治疗方法的选择需要对患者的风险因素和动脉瘤的解剖特征进行多学科评估。最近有人提出了将胸腔内血管修补术与(同时或推迟)腹部开腹手术相结合的混合疗法,但经验仍然有限,也没有有力的证据表明这种疗法能改善疗效。
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来源期刊
CiteScore
0.50
自引率
66.70%
发文量
109
审稿时长
69 days
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