Descending thoracic aortic emergencies: Past, present, and future

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC
Mohammed Habib , David Lindström , Jacob Budtz Lilly , Mario D'Oria , Anders Wanhainen , Manar Khashram , Anastasia Dean , Kevin Mani
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Abstract

The most important descending thoracic aortic (DTA) pathologies are aneurysms, dissections, and traumatic injuries. In acute settings, these conditions can constitute a significant risk of bleeding or ischemia of vital organs, resulting in a fatal outcome. Morbidity and mortality associated with aortic pathologies remain significant, despite improvements in medical therapy and endovascular techniques. In this narrative review, we present an overview of the transitions in the management of these pathologies and discuss current challenges and future perspectives. Diagnostic challenges include differentiating between thoracic aortic pathologies and cardiac diseases. Efforts have been made to identify a blood test that can rapidly differentiate these pathologies. Computed tomography is the cornerstone of diagnosing thoracic aortic emergencies. Our understanding of DTA pathologies has improved substantially due to the significant advancement in imaging modalities in the last 2 decades. On the basis of this understanding, the treatment of these pathologies has been revolutionized. Unfortunately, robust evidence from prospective and randomized studies is still lacking for the management of most DTA diseases. Medical management plays a crucial role in achieving early stability during these life-threatening emergencies. This includes intensive care monitoring, heart rate and blood pressure control, and considering permissive hypotension for patients presenting with ruptured aneurysms. Over the years, surgical management of DTA pathologies changed from open repair to endovascular repair with dedicated stent-grafts. Techniques in both spectrums have improved substantially.

胸降主动脉急症:过去、现在和未来
最重要的胸主动脉降主动脉(DTA)病变是动脉瘤、夹层和创伤性损伤。在急性情况下,这些情况可能会造成重要器官出血或缺血的重大风险,从而导致致命的后果。尽管医学治疗和血管内技术有所改进,但与主动脉病变相关的发病率和死亡率仍然显著。在这篇叙述性综述中,我们概述了这些病理学管理的转变,并讨论了当前的挑战和未来的前景。诊断挑战包括区分胸主动脉病变和心脏病。人们已经努力确定一种可以快速区分这些病理的血液测试。计算机断层扫描是诊断胸主动脉紧急情况的基石。由于在过去20年中成像模式的显著进步,我们对DTA病理学的理解有了实质性的改善。在这种认识的基础上,这些病理的治疗已经发生了革命性的变化。不幸的是,对于大多数DTA疾病的治疗,仍然缺乏前瞻性和随机研究的有力证据。在这些危及生命的紧急情况下,医疗管理在实现早期稳定方面发挥着至关重要的作用。这包括重症监护监测、心率和血压控制,以及考虑对动脉瘤破裂患者进行允许性低血压。多年来,DTA病理的外科治疗从开放性修复转变为使用专用支架移植物的血管内修复。两个频谱中的技术都有了实质性的改进。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.20
自引率
4.30%
发文量
567
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