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Current Cardiology Reports Mar 2022Acute aortic syndromes, including aortic dissection, intramural hematoma, and penetrating aortic ulcer, are a group of highly morbid, related pathologies that are... (Review)
Review
PURPOSE OF REVIEW
Acute aortic syndromes, including aortic dissection, intramural hematoma, and penetrating aortic ulcer, are a group of highly morbid, related pathologies that are defined by compromised aortic wall integrity. The purpose of this review is to summarize current management strategies for acute aortic syndromes.
RECENT FINDINGS
All acute aortic syndromes have potential for high morbidity and mortality and must be quickly identified and managed with the appropriate algorithm to prevent suboptimal outcomes. Recent trials suggest that TEVAR is increasingly useful in stabilizing pathology of the descending thoracic aorta but when possible should be applied in a delayed fashion and with limited coverage to minimize neurologic complications. Treatment for acute aortic syndrome is frequently dictated by the anatomic location and extent of the wall compromise as well as patient comorbidities. Therapy is often individualized and often includes some combination of medical, procedural, and surgical intervention.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Diseases; Hematoma; Humans; Syndrome; Ulcer
PubMed: 35029783
DOI: 10.1007/s11886-022-01642-3 -
European Journal of Vascular and... Jan 2017
Topics: Aorta, Thoracic; Aortic Diseases; Endovascular Procedures; Humans; Postoperative Complications
PubMed: 28081802
DOI: 10.1016/j.ejvs.2016.06.005 -
American Journal of Physiology. Heart... Jan 2019Thoracic aortopathy, especially aneurysm, dissection, and rupture, is responsible for significant morbidity and mortality. Uncontrolled hypertension and aging are... (Review)
Review
Thoracic aortopathy, especially aneurysm, dissection, and rupture, is responsible for significant morbidity and mortality. Uncontrolled hypertension and aging are primary risk factors for such conditions, and they contribute to an increase in the mechanical stress on the wall and an increase in its structural vulnerability, respectively. Select genetic mutations also predispose to these lethal conditions, and the collection of known mutations suggests that dysfunctional mechanosensing and mechanoregulation of the extracellular matrix may contribute to pathogenesis and disease progression. In the absence of a well-accepted pharmacotherapy, nonsurgical treatments tend to focus on reducing the mechanical loading on the aorta, particularly via the use of antihypertensive medications and recommendations to avoid strenuous exercises such as weight lifting. In this brief review, we discuss the important effects of central artery stiffening on global hemodynamics and, in particular, on the increase in pulse pressure that acts on the proximal thoracic aorta. We consider Marfan syndrome as an illustrative aortopathy but discuss other conditions leading to thoracic aortic aneurysm and dissection. We highlight the importance of phenotyping the aorta biomechanically, not just clinically, and emphasize the utility of mouse models in elucidating molecular and mechanical mechanisms of disease. Notwithstanding the widely recognized role of central artery stiffening in driving end-organ disease, we suggest that there is similarly a need to consider its key role in thoracic aortopathy.
Topics: Animals; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Humans; Marfan Syndrome; Vascular Stiffness
PubMed: 30412443
DOI: 10.1152/ajpheart.00205.2018 -
Arteriosclerosis, Thrombosis, and... Jun 2017
Review
Topics: Animals; Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Disease Models, Animal; Humans; Risk Factors; Signal Transduction; Vascular Remodeling
PubMed: 28539494
DOI: 10.1161/ATVBAHA.117.309578 -
JACC. Cardiovascular Imaging Jun 2018In diagnosing and following patients with acute aortic syndromes and thoracic aortic aneurysms, high-quality imaging of the thoracic aorta is indispensable. Mainstay... (Review)
Review
In diagnosing and following patients with acute aortic syndromes and thoracic aortic aneurysms, high-quality imaging of the thoracic aorta is indispensable. Mainstay modalities for thoracic aortic imaging are echocardiography, computed tomographic angiography, and magnetic resonance angiography. For any given clinical scenario, the imaging modality and protocol chosen will have a significant impact on sensitivity and specificity for the aortic diagnosis of concern. Imaging can also provide important ancillary information regarding myocardial performance, aortic valve morphology and function, and end-organ perfusion. Surveillance of patients following thoracic aortic surgery with serial imaging studies can identify complications that may require reintervention, and imaging has played an integral role in development of new surgical and interventional methods. Emerging techniques in thoracic aortic imaging include positron emission tomography, which addresses vessel wall inflammation, and 4-dimensional magnetic resonance angiography, which illustrates flow dynamics.
Topics: Aorta, Thoracic; Aortic Diseases; Hemodynamics; Humans; Multimodal Imaging; Predictive Value of Tests; Prognosis; Regional Blood Flow
PubMed: 29880113
DOI: 10.1016/j.jcmg.2018.03.009 -
Circulation May 2020Inherited thoracic aortopathies denote a group of congenital conditions that predispose to disease of the thoracic aorta. Aortic wall weakness and abnormal aortic... (Review)
Review
Inherited thoracic aortopathies denote a group of congenital conditions that predispose to disease of the thoracic aorta. Aortic wall weakness and abnormal aortic hemodynamic profiles predispose these patients to dilatation of the thoracic aorta, which is generally silent but can precipitate aortic dissection or rupture with devastating and often fatal consequences. Current strategies to assess the future risk of aortic dissection or rupture are based primarily on monitoring aortic diameter. However, diameter alone is a poor predictor of risk, with many patients experiencing dissection or rupture below current intervention thresholds. Developing tools that improve the risk assessment of those with aortopathy is internationally regarded as a research priority. A robust understanding of the molecular pathways that lead to aortic wall weakness is required to identify biomarkers and therapeutic targets that could improve patient management. Here, we summarize the current understanding of the genetically determined mechanisms underlying inherited aortopathies and critically appraise the available blood biomarkers, imaging techniques, and therapeutic targets that have shown promise for improving the management of patients with these important and potentially fatal conditions.
Topics: Aortic Dissection; Animals; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Aortic Rupture; Biomarkers; Genetic Predisposition to Disease; Humans; Molecular Targeted Therapy; Phenotype; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Signal Transduction; Translational Research, Biomedical; Vascular Surgical Procedures
PubMed: 32392100
DOI: 10.1161/CIRCULATIONAHA.119.043756 -
Interactive Cardiovascular and Thoracic... Nov 2022
Topics: Humans; Aorta, Thoracic; Thorax
PubMed: 36394267
DOI: 10.1093/icvts/ivac270 -
Journal of Cardiothoracic Surgery Apr 2020Blunt thoracic aortic injury, a life-threatening concern, remains the second most common cause of mortality among all non-penetrating traumatic injuries, second only to... (Review)
Review
BACKGROUND
Blunt thoracic aortic injury, a life-threatening concern, remains the second most common cause of mortality among all non-penetrating traumatic injuries, second only to intracranial hemorrhage. Kinetic forces from the rapid deceleration are the impetus for the injury mechanism and are graded accordingly. Given the prevalence of trauma as a public health problem, contemporary management considerations are important.
MAIN BODY
Blunt thoracic aortic injury may be fatal if not diagnosed and treated expeditiously. Endovascular options allow safe and effective management of these dangerous injuries. This paper describes the overview of blunt thoracic aortic trauma, the epidemiology, presentation, diagnosis, and treatment options with a focus on endovascular management.
CONCLUSION
Blunt thoracic aortic injury requires a high index of suspicion based on mechanism of injury in the trauma population. Endovascular options have become the mainstay of blunt thoracic aortic injury treatment whenever feasible with satisfactory results and long-term outcomes.
Topics: Aorta, Thoracic; Diagnostic Imaging; Endovascular Procedures; Humans; Postoperative Complications; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 32307000
DOI: 10.1186/s13019-020-01101-6 -
Presse Medicale (Paris, France : 1983) Feb 2018Degenerative aneurysms of the thoracic aorta are increasing in prevalence. The recognition of the decreased morbidity of this approach compared with open repair was... (Review)
Review
Degenerative aneurysms of the thoracic aorta are increasing in prevalence. The recognition of the decreased morbidity of this approach compared with open repair was readily apparent, as it avoided left thoracotomy, aortic cross-clamping, and left heart bypass. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution. Since then, TEVAR is increasingly being used for other aortic pathologies such as complicated type B dissection, traumatic aortic transection, and aneurysmal disease extending into the arch or visceral segment, requiring debranching procedures.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Computed Tomography Angiography; Endovascular Procedures; Humans; Magnetic Resonance Angiography; Prosthesis Implantation
PubMed: 29482890
DOI: 10.1016/j.lpm.2017.12.004 -
Arteriosclerosis, Thrombosis, and... Jul 2023
Topics: Humans; Aorta; Aorta, Thoracic; Signal Transduction; Integrins; Aortic Aneurysm, Thoracic
PubMed: 37165879
DOI: 10.1161/ATVBAHA.123.319404