Interventional treatment strategies of thoracic aortic pathologies

摘要

Chronic and acute diseases of the thoracic aorta, including aortic dissection and aortic aneurysm are attracting increasing attention both in the light of an ageing Western and Oriental population and with the proliferation of modern diagnostic imaging modalities. While classical surgical strategies still dominate the care for acute and chronic pathology of the ascending aorta and the proximal arch region, new endovascular concepts are emerging and are likely to evolve as primary treatment strategies for descending aortic pathology in suitable patients constituting the majority of cases. Additionally, aortic arch pathologies are becoming the target of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in the attempt to improve outcome by avoiding the high risk of open arch repair or complete replacement. Nonetheless, due to the complexity of the underlying vascular disease, every patient should be discussed in a team consisting of cardiologists, cardiac surgeons, anaesthesiologists and radiologists and an individualized therapeutic strategy should be carried out in a center with experience in both endovascular and surgical procedures.