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  • 1.

    【2hr】Influence of Cardiovascular Risk Factors on Aortic Wall Motion After Repair of Type A Aortic Dissection

    包量

    机译 心血管危险因素对A型主动脉夹层修复后主动脉壁运动的影响
    摘要：Background: We aimed to evaluate size changes of the thoracic aorta during the cardiac cycle with dynamic computed tomographic angiography (CTA) at specific anatomic landmarks in patients who previously underwent ascending aorta repair because of type A dissection, and to correlate aortic wall motion with several cardiovascular risk factors. Methods: From December 2008 to December 2010, 18 patients (14 men and 4 women, mean age 64 ± 12 years) with previous aortic repair underwent electrocardiography-gated CTA follow-up. Aortic systolic and diastolic diameter and cross-sectional area were measured at 4 levels: 1 cm proximal (level A) and 1 (B), 3 (C), and 10 cm (D) distal to the origin of the left subclavian artery. Results were assessed according to age and presence of diabetes, hypertension, and smoking. Results: This morpho-functional evaluation of aortic wall motion demonstrated a significant influence (P < 0.05) of hypertension at level A and D and diabetes at level D. Smoking had a borderline significance at level C and D. No significant correlation with age was evident, with results not significantly different in patients ≤ 55 and > 55 years. Conclusions: Smoking, diabetes, and hypertension play a role in impairing aortic size variations. These variations might predict wall structural alterations due to cardiovascular risk factors before they become morphologically evident. This might influence timing of surveillance following repair of acute dissection, allowing it to be specifically tailored for any single subject.
  • 2.

    【2hr】Lessons from Animal Models of Arterial Aneurysm

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    机译 动脉瘤动物模型的经验教训
    摘要：We review the results from the most common animal models of arterial aneurysm, including recent findings from our novel, laparoscopy-based pig model of abdominal aortic aneurysm, that contribute important insights into early pathogenesis. We emphasize the relevance of these findings for evaluation of treatment protocols and novel device prototypes for mechanism-based prevention of progression and rupture.
  • 3.

    【2hr】Acute Total Occlusion of the Abdominal Aorta in an Elderly Patient with Atrial Fibrillation

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    机译 老年房颤患者的腹主动脉急性完全闭塞
    摘要：A 76-year-old man without regular anticoagulation therapy for his atrial fibrillation was found to have a complete occlusion of the abdominal aorta and bilateral iliac and femoral arteries, confirmed by multi-slice computed tomography angiography. Prompt diagnosis and immediate intervention are important to minimize complications and avoid fatal outcome whenever arterial occlusion is suspected or diagnosed.
  • 4.

    【2hr】The Impact of a Blood Conservation Program in Complex Aortic Surgery

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    机译 血液保存计划在复杂主动脉手术中的影响
    摘要：Objective: Recent Society of Thoracic Surgeons and Society of Cardiovascular Anesthesiologists (STS/SCA) guidelines highlight the safety of blood conservation strategies in routine cardiac surgery. We evaluated the feasibility and impact of such a program in complex aortic surgery. Methods: Between March 2010 and October 2011, 63 consecutive aortic replacement procedures were performed: aortic root (n = 17; 27%), ascending aorta (n = 15; 23.8%), aortic arch (n = 19; 30.2%), descending aorta (n = 8; 12.7%), and thoracoabdominal aorta (n = 4; 6.3%). Aortic dissections were present in 32 patients. A multidisciplinary approach to blood conservation included minimal perioperative crystalloid, small priming circuits, hemoconcentration, meticulous hemostasis, and tolerance of postoperative anemia (hemoglobin of ≥ 7mg/dL). Results: Operative mortality was 11.1%. Multivariate predictors of mortality were low preoperative hematocrit (HCT, P = 0.05) and endocarditis (P = 0.021). Seventy-four percent of patients required no intraoperative packed red blood cell (pRBC) transfusion. For nondissection patients, 80.6% required ≤ 1 U of intraoperatively compared to 54.3% in STS benchmark data (P < 0.0001). During the hospital stay, 24 patients (39%) received no pRBCs and 34 patients (54%) received ≤ 1 U of pRBCs. Multivariate predictors of pRBC transfusion were low preoperative HCT (P = 0.04) and cardiopulmonary bypass time (P = 0.01). Discharge hemoglobin/HCT values were 8.7/26.3 compared to preoperative 12.1/35.5 (p < 0.001). Complications were absent in 94% (32/34) of patients receiving ≤1 U compared to 59% (17/29) in patients who received ≥ 2 U (P = 0.001). Conclusions: These findings demonstrate that a perioperative blood conservation management strategy can be extended to complex aortic surgery and is associated with better clinical outcomes.
  • 5.

    【2hr】A Single-Stage Repair of Arch and Descending Thoracic Aortic Aneurysms Using Jotec E-vita Open Plus Hybrid Stent Graft Combined With Antegrade Deployment of Thoracic Endograft

    包量

    机译 使用Jotec E-vita Open Plus混合支架移植与胸腔内植入物整体部署相结合的单阶段修复足弓和降主动脉瘤
    摘要：We report a unique case of a 63-year-old female with extensive peripheral vascular disease who underwent a single-stage surgical repair of the aortic arch and descending thoracic aortic aneurysm utilizing the Jotec E-vita Open Plus hybrid stent graft system combined with antegrade deployment of a thoracic endograft via a median sternotomy.
  • 6.

    【2hr】An Ascending Aortic Rent with a Saccular Aneurysm: Role of Multimodality Imaging

    包量

    机译 囊性动脉瘤的升主动脉房租：多模态成像的作用。
    摘要：We report an unusual case of 26 year old previously healthy man who presented with exertional breathlessness of 6 months duration with clinical findings suggestive of moderate aortic regurgitation (AR). There was no previous history suggestive of trauma or chest pain. Trans-thoracic and trans-esophageal echocardiography showed an ascending aortic aneurysm compressing the Left atrium and presence of moderate AR. A 64 slice cardiac CT with intraaortic endoscopic reconstruction further clarified the anatomy. This revealed an ascending aortic aneurysm, extending into the middle mediastinum with a clear rent in the ascending aorta, communicating with the aneurysm. More importantly, CT imaging also confirmed the absence of a dissection flap. The case demonstrates the usefulness of multimodality imaging in defining the morpho-anatomic features in such unusual situations.
  • 7.

    【2hr】Health-Related Quality of Life in Thoracic Aortic Disease: Part I. Cases Managed Non-operatively

    包量

    机译 胸主动脉疾病的健康相关生活质量：第一部分非手术治疗病例
    摘要：>Background: The health-related quality of life (HRQOL) in subjects with chronic thoracic aortic disease (TAD) not scheduled for intervention has not been previously reported. Such information may aid counseling, management, and clinical decision-making. We report HRQOL in TAD, its main subtypes (aneurysm versus dissection and proximal versus distal), compare it to a reference group from the general population, and explore independent predictors. >Methods: The short-form 36-item (SF-36) questionnaire was used, as part of a self-reporting health survey, to measure HRQOL in eight domains and a physical component summary (PCS) and a mental component summary (MCS) score. Median differences (Δ) between the component summary scores and a sex- and age-matched reference group from the general population were the primary outcome measures. Multivariable techniques were used to evaluate independent predictors. >Results: In 178 TAD subjects, the HRQOL was reduced (versus the reference group) in the PCS, Δ −6.4 [95% confidence limits −8.8, −4.0] and in three out of eight SF-36 domains: physical functioning (PF), Δ −10 [−15, −4.5]; physical role (RP), Δ −25 [−34, −16]; general health (GH), Δ −5.0 [−9.7, −0.27]. There were no statistically significant differences in HRQOL scores in type (aneurysm versus dissection) or location (proximal versus distal) of TAD. Multivariable analyses identified symptoms of exertional dyspnea, exertional calf pain, joint pain, and angina pectoris as predictors of lower SF-36 component summary scores. >Conclusions: The HRQOL in subjects with chronic TAD is reduced compared to a matched reference group. Differences, however, are comparably small and limited to physical domains. There were no differences according to type or location of TAD. Present symptoms and conditions were influential on the physical and mental component summary scores. HRQOL could be a useful part of thoracic aortic disease surveillance and could help guide interventional decision-making.
  • 8.

    【2hr】Health-Related Quality of Life in Thoracic Aortic Disease: Part II. After Surgery on the Proximal (Root Ascending Arch) Aorta

    包量

    机译 胸主动脉疾病的健康相关生活质量：第二部分。手术后近端（根升弓）主动脉
    摘要：Background: Health-related quality of life (HRQOL) has been reported to be near-to-normal after operations on the proximal aorta. However, a thorough evaluation of variables related to postoperative HRQOL is lacking. We report HRQOL after surgery on the proximal aorta acknowledging current symptoms and conditions. If modifiable factors affect HRQOL, surgical treatment could be tailored to optimize outcomes. Methods: The short form 36 item (SF-36) questionnaire was used to measure HRQOL in eight domains and a physical component summary (PCS) and mental component summary (MCS) score. Median differences (Δ) between the component summary scores and a sex- and age-matched reference group from the general population were the primary outcome measures, along with comparisons of patient subgroups according to pathology (aneurysm versus dissection), aortic valve procedure, and circulatory arrest. Results: In 207 patients operated on the proximal aorta, after a mean of three years, there were no significant differences in median PCS (Δ = −0.3 [95% confidence limits −2.6, 2.0]) and MCS (Δ = 1.7 [−0.4, 2.9]) scores compared to the reference group, but median scores for the physical functioning, general health, and mental health domains were significantly lower. There were no statistically significant differences in PCS, MCS, or domain scores for patients with aneurysm versus dissection, for patients undergoing aortic valve procedures or not, or for patients managed with circulatory arrest or not. In multivariable analysis, exertional dyspnea was independently related to both ΔPCS (−6.5 [−13, −0.44]) and ΔMCS (−7.5 [−13, −1.6]), whereas age, exertional calf pain, and myocardial infarction were related only to ΔPCS. Conclusions: Overall HRQOL after surgery on the proximal aorta is encouraging, which remains important when benchmarking against novel therapeutic procedures. At follow-up, HRQOL appears related to current symptoms and conditions, but not to operative procedures. To better understand their impact on HRQOL, prospective studies comparing pre- and postoperative scores are needed.
  • 9.

    【2hr】Contemporary Role of Computational Analysis in Endovascular Treatment for Thoracic Aortic Disease

    包量

    机译 计算分析在胸主动脉血管内治疗中的当代作用
    摘要：In the past decade, thoracic endovascular aortic repair (TEVAR) has become the primary treatment option in descending aneurysm and dissection. The clinical outcome of this minimally invasive technique is strictly related to an appropriate patient/stent graft selection, hemodynamic interactions, and operator skills. In this context, a quantitative assessment of the biomechanical stress induced in the aortic wall due to the stent graft may support the planning of the procedure. Different techniques of medical imaging, like computed tomography or magnetic resonance imaging, can be used to evaluate dynamics in the thoracic aorta. Such information can also be combined with dedicated patient-specific computer-based simulations, to provide a further insight into the biomechanical aspects. In clinical practice, computational analysis might show the development of aortic disease, such as the aortic wall segments which experience higher stress in places where rupture and dissection may occur. In aortic dissections, the intimal tear is usually located at the level of the sino-tubular junction and/or at the origin of the left subclavian artery. Besides, computational models may potentially be used preoperatively to predict stent graft behavior, virtually testing the optimal stent graft sizing, deployment, and conformability, in order to provide the best endovascular treatment. The present study reviews the current literature regarding the use of computational tools for TEVAR biomechanics, highlighting their potential clinical applications.
  • 10.

    【2hr】A Perspective on Natural History and Survival in Nonoperated Thoracic Aortic Aneurysm Patients

    包量

    机译 非手术性胸主动脉瘤患者自然史和生存的观点。
    摘要：There are many questions that remain unanswered in the understanding of the natural history of thoracic aortic aneurysm (TAA). This review will critically appraise the current published evidence on the natural history of TAA in nonoperated patients and their present rates of survival.
  • 11.

    【2hr】True Aneurysm of the Proximal Brachial Artery

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    机译 臂近端动脉的真正动脉瘤
    摘要：A 35-year-old farmer presented with complaints of pain in the right upper limb for 1 month and bluish discoloration of the right-hand finger tips with tingling and numbness. He sustained injury to the right upper limb while lifting a heavy object 1 mo previously. There was an ovoid swelling of 4 × 2 cm on the medial aspect of the right arm, 12 cm above the medial epicondyle at the level of the armpit with visible pulsations. There was distal neurovascular deficit. Duplex scan of the right upper limb arterial system revealed a pseudoaneurysm of the proximal right brachial artery, with dampened monophasic flow in the ulnar artery and no flow in the radial artery. Spiral computed tomography angiogram showed the presence of an echogenic periarterial lesion in the proximal brachial artery suggestive of pseudoaneurysm or an extrinsic compression by hematoma. Distal brachial artery was found to have filled with thrombus, with non-opacification of the radial and the distal ulnar artery. The patient was posted for excision of the aneurysmal arterial segment. A 5-cm-long reversed segment of vein graft was interposed in between the cut ends of the brachial artery. Histopathology: Specimen shows a part of the vessel wall composed of intimal, medial, and adventitial layers with intraluminal thrombus showing evidence of recanalization suggestive of true aneurysm of the brachial artery.
  • 12.

    【2hr】Life-Threatening Surgery for Mycotic Aneurysm

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    机译 危及生命的真菌性动脉瘤手术
    摘要：Infected aneurysm (or mycotic aneurysm) is defined as an infectious disease of the wall of an artery with formation of a blind, saccular out-pouching that is contiguous with the arterial lumen. Symptoms are frequently absent or nonspecific during the early stages. Once clinically presented, infected aneurysms are often at an advanced stage of development and associated with complications such as rupture. Nontreatment or delayed treatment of infected aneurysms has a poor outcome, with high morbidity and mortality rate via fulminant sepsis or hemorrhage. In clinically suspected cases, computed tomography is used for diagnosis. Urgent surgery, performed to prevent aortic rupture carries high morbidity and mortality rates.
  • 13.

    【2hr】Magnetic Resonance Imaging Findings in a Positron Emission Tomography-Positive Thoracic Aortic Aneurysm

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    机译 正电子发射断层扫描-正胸主动脉瘤的磁共振成像发现。
    摘要：Diffusion-weighted MRI (DW-MRI) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) findings are described in a patient with a thoracic aortic aneurysm. Both examinations have the ability to noninvasively assess biological processes associated with aneurysm instability and therefore to potentially impact clinical decision-making regardless of the vessel size. Despite similarities between images on both techniques, FDG-PET evaluates glycolysis, while DW-MRI evaluates cell density, edema, and perfusion. Longitudinal studies including larger patient numbers are needed to investigate the temporal continuum and clinical significance of these findings.
  • 14.

    【2hr】Imaging of Thoracic Intercostal Artery Rupture during the Propagation of a Type B Acute Aortic Syndrome

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    机译 B型急性主动脉综合征的传播过程中胸肋间动脉破裂的成像。
    摘要：The natural history of an intramural hematoma (IMH) has not been completely defined. This is a case report of a 63-year-old woman, in whom imaging reveals intercostal artery rupture during the process of expansion of an IMH in a Type B acute aortic syndrome. This case demonstrates that intercostal artery rupture may act as a precursor for the transformation of IMH to a classical dissection. Interestingly, complete resolution of this condition is achieved through medical management.
  • 15.

    【2hr】Reasons to Investigate the Soluble Receptor for Advanced Glycation End-Product (sRAGE) Pathway in Aortic Disease

    包量

    机译 调查主动脉疾病中晚期糖基化终产物（sRAGE）途径的可溶性受体的原因
    摘要：Aortic disease has a high rate of morbidity and mortality, and there are no documented screening methods to date. Yet biochemical research does show a significant link between soluble receptor for advanced glycation end-products (sRAGE) protein and cardiovascular disease. Therefore, it can be hypothesized that sRAGE plasma levels may help differentiate patients with aortic disease from the general population, which this paper will review and present.
  • 16.

    【2hr】From Ebers to EVARs: A Historical Perspective on Aortic Surgery

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    机译 从Eber到EVAR：主动脉手术的历史视角
    摘要：Pathology of the aorta has been recognized for nearly three and a half millennia, dating back to the first recorded description in the scrolls of Ebers, circa 1550 BC. Since that time, treatment has evolved from magical medicinal remedies and incantations to nearly outpatient percutaneous interventions. From the first attempts at open surgical reconstruction in the 1700s and 1800s, to the latest generations of endovascular devices, innovative pioneers have pushed the envelope of surgical technique in developing unique and novel strategies to treat the ever complex pathology of the aorta. We are just now beginning to understand these pathologies at the molecular and genetic levels, and with that expansive extent of investigation enters a journal, dedicated solely to the aorta. With this article, we hope to illuminate the rich and deep history of aortic pathology, and the innovations leading to the technology of today. A firm understanding of our past provides a strong foundation for further growth into the future.
  • 17.

    【2hr】Painless Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection

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    机译 无痛B型主动脉夹层：国际急性主动脉夹层注册表的见解
    摘要：Introduction: The classical presentation of a patient with Type B acute aortic dissection (TBAAD) is characterized by severe chest, back, or abdominal pain, ripping or tearing in nature. However, some patients present with painless acute aortic dissection, which can lead to a delay in diagnosis and treatment. We utilized the International Registry on Acute Aortic Dissections (IRAD) database to study these patients. Methods: We analyzed 43 painless TBAAD patients enrolled in the database between January 1996 and July 2012. The differences in presentation, diagnostics, management, and outcome were compared with patients presenting with painful TBAAD. Results: Among the 1162 TBAAD patients enrolled in IRAD, 43 patients presented with painless TBAAD (3.7%). The mean age of patients with painless TBAAD was significantly higher than normal TBAAD patients (69.2 versus 63.3 years, P = 0.020). The presence of atherosclerosis (46.4% versus 30.1%, P = 0.022), diabetes (17.9% versus 7.5%; P = 0.018), and other aortic diseases (8.6% versus 2.3%, P= 0.051), such as prior aortic aneurysm (31% versus 18.8% P = 0.049) was more common in these patients. Median delay time between presentation and diagnosis was longer in painless patients (median 34.0 versus 19.0 hours; P = 0.006). Dissection of iatrogenic origin (19.5% versus 1.3%; P < 0.001) was significantly more frequent in the painless group. The in-hospital mortality was 18.6% in the painless group, compared with an in-hospital mortality of 9.9% in the control group (P = 0.063). Conclusion: Painless TBAAD is a relatively rare presentation (3.7%) of aortic dissection, and is often associated with a history of atherosclerosis, diabetes, prior aortic disease including aortic aneurysm, and an iatrogenic origin. We observed a trend for increased in-hospital mortality in painless TBAAD patients, which may be the result of a delay in diagnosis and management. Therefore, physicians should be aware of this relative rare presentation of TBAAD.
  • 18.

    【2hr】Outcomes of Aortic Arch Replacement Performed Without Circulatory Arrest or Deep Hypothermia

    包量

    机译 在没有循环骤停或深低温的情况下进行主动脉弓置换的结果
    摘要：Background: Aortic arch replacement using standard techniques, including deep hypothermic circulatory arrest and selective antegrade cerebral perfusion, is still associated with significant mortality and cerebral morbidity. We have previously described the “branch-first” technique that avoids circulatory arrest or profound hypothermia with excellent outcomes. We now describe our clinical experience with a larger cohort of patients as well as follow-up of our earlier results. We also describe a further technical simplification to this technique. Methods: From 2005 to 2010, 43 patients underwent a “branch-first continuous perfusion” technique for aortic arch replacement. In this technique, arterial perfusion is peripheral, usually by femoral inflow. Disconnection of each arch branch and anastomosis to a perfused trifurcation graft proceeds sequentially from the innominate to the left subclavian artery, with uninterrupted perfusion of the heart and viscera by the peripheral cannula. In the first cohort perfusion to the trifurcation graft was by right axillary cannulation. Since 2009, a modification was introduced such that perfusion is supplied directly by a sidearm on the trifurcation graft. This was used in the last 18 patients of this series. After reconstruction of the debranched arch and ascending aorta, the common stem of the trifurcation graft is anastomosed to the arch graft. In this series, there were 27 males, and mean age was 63 ± 13 years. Fifteen cases (35%) were performed with urgent/emergent priority. Nineteen patients (44%) were operated for aortic dissection, and the remainder for aneurysms. Seven patients (16%) had previously undergone a cardiac surgical procedure. Results: There were two (4.7%) early mortalities while one patient (2.3%) experienced a permanent stroke. One patient (2%) required mechanical support while three (7%) required hemofiltration for renal support. Extubation was achieved within 24 hours in 21 patients (49%) while 19 (42%) were discharged from the Intensive Care Unit (ICU) within two days. Eight patients (19%) did not require any transfusion of red cells or platelets. Mean follow-up duration was 21 ± 19 months and was 100% complete. At three years, survival was 95 ± 3.2%. No patients required subsequent aortic reoperation during this early follow-up period. Conclusions: This modified branch-first continuous perfusion technique brings us closer to the goal of arch surgery without cerebral or visceral circulatory arrest and the morbidity of deep hypothermia. Our early experience is encouraging although greater numbers and longer follow-up will reveal the full potential of this approach.
  • 19.

    【2hr】Urgent Carotid Endarterectomy in Patients with Acute Neurological Symptoms: The Results of a Single Center Prospective Nonrandomized Study

    包量

    机译 急性神经系统症状的患者紧急颈动脉内膜切除术：单中心前瞻性非随机研究的结果
    摘要：Background: To evaluate the feasibility and the safety of performing urgent (within 24 hours) carotid endarterectomy in patients with carotid stenosis presenting with repetitive transient ischemic attacks or progressing stroke. Methods: Thirty consecutive patients underwent urgent carotid endarterectomy for repetitive transient ischemic attacks (N = 12) or progressing stroke (N = 18) according to the following criteria: two or more transient ischemic attacks or a fluctuating neurological deficit over a period of less than 24 hours (progressing stroke), no impairment of consciousness, no cerebral infarct larger than 1.5 cm in diameter on computed tomography and a carotid artery stenosis of 70% or more on the appropriate side, diagnosed by echodoppler ultrasonography and/or arteriography. Patients with cerebral hemorrhage were excluded. All patients were examined pre- and postoperatively by the same neurologist and surgery was performed by the same vascular surgeon. All the patients underwent a cerebral CT scan within 5 days after surgery. Results: There were 19 men and 11 women. The mean age was 71 ± 7.6 years. The time delay of surgery after the onset of transient ischemic attacks or progressing stroke averaged 19.4 ± 11.5 hours. For patients suffering progressive stroke, one developed a fatal ischemic stroke 24 hours after surgery, five showed no improvement of their neurological status after surgery, but none worsened. Twelve patients experienced significant improvement of their neurological status with an European Stroke Scale of 77.9 ± 25.2 at admission and 95.8 ± 4.6 at discharge, and all but one of those patients had a Barthel's index value over 85/100 at discharge. The 12 patients with repetitive transient ischemic attacks had an uneventful postoperative outcome. The mean duration of follow-up was 3.4 ± 1.2 years. No patient developed another transient ischemic attack or ischemic stroke during the follow-up period. Conclusions: The results of our series documented the feasibility and the safety of performing urgent (within 24 hours) carotid endarterectomy in patients presenting with repetitive transient ischemic attacks or progressing stroke. This procedure seems to us to be justified by the fact that waiting for surgery may lead to the development of a more profound deficit or another stroke in these neurologically unstable patients whose only chance for neurological recovery is in the early phase.
  • 20.

    【2hr】Acute Traumatic Thoracic Aortic Injury: Considerations and Reflections on the Endovascular Aneurysm Repair

    包量

    机译 急性创伤性胸主动脉损伤：血管内动脉瘤修复的考虑和思考
    摘要：Traumatic rupture of the thoracic aorta is a life-threatening lesion and it occurs in 10 to 30% of fatalities from blunt thoracic trauma and is the second most common cause of death after head injury. Immediate surgery is often characterized by a high mortality and morbidity rate. Delayed repair of traumatic aortic injuries has significant survival benefits and a much lower mortality rate compared with early open repair. Despite developments in operative techniques, there still remains considerable operative mortality and morbidity associated with a surgical approach even if delayed. Endovascular stent grafts for the thoracic aorta represents an alternative to the conventional approach for traumatic aortic rupture. Because of the lower invasivity avoiding thoracotomy and use of heparin, endovascular repair can be applied in acute patients without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. However, despite the good deal of convincing evidence for endovascular treatment for thoracic aortic diseases and for traumatic aortic injuries as a valid and efficacious alternative to surgery, several reports show a variety of late complications of thoracic endografts especially for first-generation stent-grafts. In light of this, is the endovascular treatment really safe, efficacious and free from complications in the long term? This manuscript aims to offer a moment of reflection on this important chapter of aortic pathology.
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