Guideline for the Treatment of Acute and Chronic Diseases of the Thoracic Aorta: Aortic Arch

Introduction

Acute and chronic diseases of the thoracic aorta have increased in prevalence and incidence and thus in clinical importance in recent years. The aortic arch, although anatomically a delimited area, is involved in many acute and chronic thoracic aortic pathologies, whether they are proximal thoracic aortic pathologies extending into or beyond the aortic arch, or pathologies of the descending aorta or thoracoabdominal aorta, beginning proximally within the aortic arch. In this respect, this delimit anatomical segment is enormously important as the relation among all three supra-aortic vessels to the underlying pathology must be constantly considered and, depending on the therapy's extent, these must be also included in the decision-making process.[1] [2] [3] [4]

Initiated by the German Society of Thoracic and Cardiovascular Surgery (DGTHG) and derived from the joint expert consensus document of the European Association for Cardio-Thoracic Surgery and European Society for Vascular Surgery, we addressed treatment strategies for acute and chronic pathologies of the thoracic aorta involving the aortic arch.[5] Together with the German societies for Interventional Radiology and Minimally Invasive Therapy (DeGIR), Anaesthesiology (DGAI), Cardiovascular Engineering (DGfK), Vascular Surgery (DGG), Neurology (DGN), Cardiology (DGK), Radiology (DRG), and, representing the patients’ interests, the German Heart Foundation (Deutsche Herzstiftung e.V.) this guideline was developed and written while consulting with the German Working Group of Scientific Medical Societies (AWMF).

Publication History

Received: 14 March 2023

Accepted: 17 March 2023

Accepted Manuscript online:
22 March 2023

Article published online:
03 May 2023

• References

• 1 Berger T, Kreibich M, Mueller F. et al. The frozen elephant trunk technique for aortic dissection is safe after previous aortic repair. Eur J Cardiothorac Surg 2021; 59 (01) 130-136
• 2 Berger T, Weiss G, Voetsch A. et al. Multicentre experience with two frozen elephant trunk prostheses in the treatment of acute aortic dissection†. Eur J Cardiothorac Surg 2019; 56 (03) 572-578
• 3 Berger T, Kreibich M, Rylski B. et al. The 3-step approach for the treatment of multisegmental thoraco-abdominal aortic pathologies. Interact Cardiovasc Thorac Surg 2021; 33 (02) 269-275
• 4 Kosiorowska M, Berezowski M, Widenka K. et al. Non-A non-B acute aortic dissection with entry tear in the aortic arch. Interact Cardiovasc Thorac Surg 2022; 34 (05) 878-884
• 5 Czerny M, Schmidli J, Adler S. et al; EACTS/ESVS scientific document group. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019; 55 (01) 133-162
• 6 Rylski B, Hahn N, Beyersdorf F. et al. Fate of the dissected aortic arch after ascending replacement in type A aortic dissection†. Eur J Cardiothorac Surg 2017; 51 (06) 1127-1134
• 7 Kreibich M, Berger T, Morlock J. et al. The frozen elephant trunk technique for the treatment of acute complicated Type B aortic dissection. Eur J Cardiothorac Surg 2018; 53 (03) 525-530
• 8 Demal TJ, Bax L, Brickwedel J. et al. Outcome of the frozen elephant trunk procedure as a redo operation. Interact Cardiovasc Thorac Surg 2021; 33 (01) 85-92
• 9 Verscheure D, Haulon S, Tsilimparis N. et al. Endovascular treatment of post type A chronic aortic arch dissection with a branched endograft: early results from a retrospective international multicenter study. Ann Surg 2021; 273 (05) 997-1003