Current status and reflections on the treatment of aortic disease
Aortic aneurysm and aortic dissection are common diseases in vascular surgery.With the development of endovascular technology,the treatment of aortic diseases has entered a brand-new stage.Due to the different anatomical conditions and hemodynamic characteristics of lesions in different parts of aorta,the difficulties and solutions are also different.Therefore,this article reviews the difficulties and solutions for aortic aneurysm and aortic dissection at differ-ent anatomical sites.Regarding endovascular treatment of aneurysms or dissection in the ascending aorta,the difficulty lies in the large variation in the diameter of the aortic during systole and diastole,which makes anchoring difficult.On the other hand,there is a lack of suitable stents for patients with a short anchoring zone.In aortic arch disease,branch stenting or fenestration techniques have achieved overall satisfactory results,but there are still limitations in the occur-rence of neurological complications due to high technical difficulty and positive correlation with the number of branches of the stent.Additionally,the in situ or pre-opening stenting technique may have potential impacts on the long-term treatment of aortic disease,which needs to been further observed.For lesions involving the thoracic and abdominal aorta,the difficulty lies in the presence of a large number of visceral branch vessels and the complication of endovascular fistu-las after stenting.Relevant branch stents have already entered the stage of multicenter clinical trials,and their long-term results need to be observed.For patients whose anatomical conditions do not meet the requirements of endovascular treat-ment,open surgery remains a reliable method,if systemic conditions allow.Therefore,for future endovascular treat-ment of aortic aneurysm and aortic dissection,more flexibal stents are needed first;additionauy,vascular surgeons should strictly follow the indications and carefully select the endovascular treatment.
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