RT Book, Section
A1 Moffatt-Bruce, Susan D.
A1 Mitchell, R. Scott
A2 Cohn, Lawrence H.
SR Print(0)
ID 55926780
T1 Chapter 54. Endovascular Therapy for the Treatment of Thoracic Aortic Disease
T2 Cardiac Surgery in the Adult, 4e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-163310-9
LK accesssurgery.mhmedical.com/content.aspx?aid=55926780
RD 2024/04/18
AB Patients  with  thoracic  aortic  disease  are  a  difficult  population  to  treat,  because  they  frequently  consist  of  an  aged  population  with  multiple  comorbidities.  The  modern  surgical  treatment  of  thoracic  aortic  diseases  began  in  the  1950s  when  successful  treatment  using  segmental  resection  and  graft  replacement  was  reported  by  Swan,  Lam,  DeBakey,  and  Etheredge.1–3  Thereafter,  DeBakey  and  Cooley  reported  the  first  successful  repair  of  an  ascending  aortic  aneurysm  using  cardiopulmonary  bypass.4  Our  understanding  of  the  pathophysiology  and  natural  history  of  thoracic  aortic  disease  has  evolved,  which  has  expanded  our  treatment  choices.5,6  In  addition,  improvements  in  diagnostic  capabilities,  surgical  techniques,  and  perioperative  care  have  resulted  in  improved  outcomes,  even  as  the  risk  profile  has  increased.  Nonetheless,  operative  intervention  in  this  patient  population  frequently  results  in  substantial  mortality  and  long-term  morbidity.7,8  The  concept  of  using  endovascular  techniques  to  treat  patients  with  thoracic  aortic  disease  emerged  a  decade  ago,  propelled  by  the  desire  to  avoid  surgical  risk  as  well  as  to  induce  reconstructive  modeling  of  the  diseased  aorta  by  initiating  a  natural  healing  process  through  exclusion  and  depressurization  of  the  aneurysmal  sac.9  In  an  effort  to  improve  outcomes  in  the  treatment  of  patients  with  thoracic  aortic  disease,  endovascular  stent-graft  technology  has  rapidly  followed  applications  on  the  abdominal  aorta.10,11  Originally  devised  for  high-risk  patients  with  multiple  comorbidities,  thoracic  stent-graft  applications  are  being  expanded  to  young  and  old  patients  with  a  variety  of  pathologies,  including  thoracic  aortic  aneurysms,  aortic  dissections,  intramural  hematomas,  penetrating  atherosclerotic  ulcers,  and  thoracic  aortic  trauma.12–19  Initial  reports  using  these  endovascular  stent-grafts  have  been  encouraging,  but  long-term  outcomes  are  unknown,  and  the  necessity  for  long-term  follow-up,  with  its  attendant  expense,  has  raised  serious  concern.20–22