CHAPTER 31 Diseases of the Aorta and Trauma to the Aorta and the Heart
Both chronic and acute diseases of the aorta, including trauma, are attracting increasing attention both in the light of an ageing Western population and with the advent of modern diagnostic modalities and therapeutic options to manage aortic pathology. For aortic aneurysm, an individual rate of expansion and the risk of rupture may be assessed from co-morbidities, hypertensive state, or connective tissue disease, and may be quantified regardless of anatomic location for timely selection and treatment. Acute aortic syndrome, a new term comprising acute dissection, intramural haematoma, and penetrating aortic ulcers, may share common ground by the observation of microapoplexy of the aortic wall, eventually leading to higher wall stress, facilitating progressive dilatation, intramural haemorrhage, dissection, and rupture; chronic hypertension and connective tissue disorders are likely to promote this mechanism as well.While classical surgical strategies still dominate 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 for descending and abdominal aortic pathology in selected and suitable patients. Additionally, aortic arch pathologies are treated in a hybrid approach combining surgical head-vessel debranching and interventional stent-graft implantation in the attempt to improve outcome. Life-threatening aortic emergencies, including aortic trauma involving the descending aorta, are accepted indications for endovascular stent-grafts.
In summary, the newly discovered field of clinical aortic pathology is unfolding; optimized multimodality diagnostic and therapeutic strategies require the collaborative effort of a multidisciplinary approach probably organized best in association with an emergency unit which includes a chest pain unit.
Chapter 28)
