Abstract
Recent studies suggest that the development of atherosclerotic descending aortic aneurysms (DAA) is a complicated process, which occurs due to a polymorphic nature of aortic wall abnormalities. They overlap and contribute to a wide variety of clinical manifestations. The inflammatory process may be the main reason for a rapid growth and rupture of the aneurysm. It also involves a mechanism of complex adhesion comprising of acute-phase proteins to low-density lipoproteins (LDLPs) as atherosclerotic lesions. This process occurs in the presence of connective tissue disorders, aortic wall focal cystic medianecrosis, poor management of arterial hypertension, aging, and reduced compliance. Therefore, the surgical treatment modality to treat DAA becomes less appealing. Additionally, it is not feasible to make indications for surgery based solely on linear aneurysmal diameter. However, medical correction has no contraindications for use.
Highlights
Due to the similarity of etiopathogenetic processes involved in, the aortic wall contributing to the lesion, we used a ‘mixed’ term ‘descending aortic aneurysms’ (DAA) instead of ‘descending thoracic aneurysm (DTA) and abdominal aortic aneurysm (AAA)
Differential diagnosis and treatment of DAA currently represents challenge due to polymorphous nature of processes occurring in the aortic wall, which overlapping make a variety of clinical manifestations, and each of them need, to considered and addressed
It is time to shift from a too simplified assessment of DAA progression, such as the aneurysm diameter offering no integral view of pathological changes involved
Summary
Due to the similarity of etiopathogenetic processes involved in, the aortic wall contributing to the lesion, we used a ‘mixed’ term ‘descending aortic aneurysms’ (DAA) instead of ‘descending thoracic aneurysm (DTA) and abdominal aortic aneurysm (AAA).Up to 25% of all DAA cases include DTA, whereas other cases involve abdominal aorta [1,2-3]. The abovementioned factors further increase already high mortality after aortic prosthesis operations (valve) by 32-60% [5] In this respect, Rachael O et al [6] believe that the risks associated with the operative treatment and 30-day mortality rate up to 5% require improvements in individualized diagnostic and therapeutic approaches to treatment in these patients. Rachael O et al [6] believe that the risks associated with the operative treatment and 30-day mortality rate up to 5% require improvements in individualized diagnostic and therapeutic approaches to treatment in these patients This is a key task that can promote a better clinical outcome in the presence of risk factors and more significant perioperative changes
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