Principles and recent advances in the treatment of thoracoabdominal aortic aneurysms

A thoracic aortic coarctation aneurysm is not a tumor growing on the thoracic aorta, but an aneurysm formed when the wall of the thoracic aorta is damaged by certain pathological factors and the high speed and high pressure aortic blood flow tears its inner membrane, causing the inner and outer membranes of the aorta to separate, forming a coarctation and leading to the expansion of the outer membrane of the thoracic aorta near the rupture. The danger is that the outer membrane of the wall of the thoracic aorta, where aneurysmal expansion occurs, may rupture at any time leading to rapid bleeding and death of the patient. Common causes of thoracic aortic coarctation aneurysms include hypertension, atherosclerosis, medically induced injury, inflammation, and Marfan’s syndrome (thoracic aortic aneurysm, long bone overgrowth, and lens hemicrania syndrome). Marfan’s syndrome is a congenital, hereditary disease in which the patient has a slender figure due to long bones and therefore has an advantage in sports, but such patients often die of aneurysm rupture in their youth and are therefore called “athlete killers. However, these patients often die of aneurysm rupture in their youth and are therefore called “athlete killers”. The incidence of thoracic aortic coarctation aneurysms is high, about 1/10,000/year in the United States. The disease is classified into type A and type B, depending on the location of the lesion, with the former referring to a coarctation involving the ascending aorta, and the latter referring to a rupture of the aortic intima distal to the left subclavian artery, with the coarctation involving only the descending aorta. Approximately 10% of the clogged aneurysms involve the ascending aorta, and approximately 90% involve the descending aorta. Since rupture of a thoracic aortic coarctation aneurysm can lead to rapid death and is like a time bomb in the body, it should be treated as soon as it is diagnosed. In 1955, the famous American vascular surgeons Debakey and Cooley performed the first transthoracic Since then, the procedure has become the classic treatment for thoracic aortic coarctation aneurysms. The procedure varies slightly depending on the location of the coarcted aortic aneurysm, and the general steps include opening the chest, dissecting the thoracic aorta, blocking the blood flow in the thoracic aorta, removing the diseased section of the thoracic aorta, and anastomosing the ends of the artificial vessel to the normal aorta at each end of the lesion. In this way, the aneurysm that may rupture at any time is removed, and the treatment purpose of preventing aneurysm rupture is achieved. It can also be seen that open-heart aortic replacement is a very traumatic procedure, which often puts both doctors and patients in an awkward dilemma due to its high complication and mortality rates. The emergence of intracavitary isolation of coarctation aneurysms in the 1990s has brought the treatment of coarctation aneurysms of the thoracic aorta into a new, minimally invasive era. As long as the artificial vessel is used to isolate the high speed and high pressure blood flow of the thoracic aorta from the diseased vessel wall, so that the blood flow no longer enters the interlayer through the endothelial rupture but enters the distal aorta and no longer impacts the dilated outer membrane of the thoracic aorta, the rupture can be prevented and cured. A cure is achieved. The endoluminal isolation procedure is to preposition an artificial vessel with a titanium memory alloy stent that matches the diseased thoracic aorta in the catheter and introduce it through the femoral artery under X-ray fluoroscopic surveillance. The blood flow is then passed through the lumen of the artificial vessel, and the endothelial rupture and aneurysmal expansion of the thoracic aortic coarctation are isolated. The endoluminal rupture and aneurysmal dilatation of the thoracic aortic coarctation are isolated. Endoluminal isolation is applicable to type B coarctation aortic aneurysms as long as the endoluminal rupture is more than 1.5 cm from the opening of the left subclavian artery and the proximal end of the artificial vessel can be fixed above the endoluminal rupture without blocking the left subclavian artery. Compared with traditional open-heart surgery, the most prominent feature of endoluminal isolation is that it is minimally invasive, requiring only a small 3-cm-long incision at the base of the thigh. Thus, the emergence of endoluminal isolation has become another revolution in the history of surgical treatment of thoracic aortic coarctation aneurysms. In China, Professor Jing Zaiping, a famous vascular surgeon of Changhai Hospital, took the lead in carrying out endoluminal isolation for the treatment of thoracic aortic coarctation aneurysm, making China hold the world advanced level in this technology.