Erkrankungen der thorakalen Aorta – welche Therapie für welchen Abschnitt?

Abstract

The management of thoracic aortic pathology has been evolving to be truly interdisciplinary. The last few years have witnessed the increasing interplay between the open-surgical and endovascular therapy. Based on this, an interdisciplinary approach to diagnosis and therapy is highly recommended. The localization and extent of the pathology is currently the main indicator of the preferred therapy, whether complete surgical, hybrid or complete endovascular. For the aortic root and the ascending aorta, the surgical therapy is the first choice. Pathology of the aortic arch and proximal descending aorta are now preferably treated using a hybrid approach, this means a surgical debranching of the aortic arch with endovascular stenting of the aortic arch and the descending aorta. For the descending aorta, the endovascular stenting is considered the therapy of choice. The management of the thoracic aorta is undergoing continuous development. Aortic arch pathology has been traditionally treated with complete surgical arch replacement under hypothermic circulatory arrest, which was correlated with high cerebrovascular events. The evolution of aortic arch therapy into arch debranching with selective antegrade cerebral perfusion and endovascular stenting of the aorta improved the neurological results and patient survival substantially. The cardiac surgeons are now working on a transapical endovascular therapy for Stanford Type-A aortic dissection. This therapy form is still in an early phase with a few published case reports but it is considered to be an effective adjuvant to the standard surgical therapy of the aorta in the near future. Kardiologie up2date 11 e2015 Erkrankungen der thorakalen Aorta – welche Therapie fur welchen Abschnitt? 232 D ie se s D ok um en t w ur de z um p er so nl ic he n G eb ra uc h he ru nt er ge la de n. V er vi el fa lti gu ng n ur m it Z us tim m un g de s V er la ge s.