2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).

Autores/Miembros del Grupo de Trabajo: Raimund Erbel (Coordinador) (Alemania), Victor Aboyans (Coordinador) (Francia), Catherine Boileau (Francia), Eduardo Bossone (Italia), Roberto Di Bartolomeo (Italia), Holger Eggebrecht (Alemania), Arturo Evangelista (Espana), Volkmar Falk (Suiza), Herbert Frank (Austria), Oliver Gaemperli (Suiza), Martin Grabenwoger (Austria), Axel Haverich (Alemania), Bernard Iung (Francia), Athanasios John Manolis (Grecia), Folkert Meijboom (Paises Bajos), Christoph A. Nienaber (Alemania), Marco Roffi (Suiza), Herve Rousseau (Francia), Udo Sechtem (Alemania), Per Anton Sirnes (Noruega), Regula S. von Allmen (Suiza) y Christiaan J.M. Vrints (Belgica)

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases

https://www.zora.uzh.ch/id/eprint/146170/1/1-s2.0-S1078588416301782-main.pdf

Editor's Choice - Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

3D
: three-dimensional
AAA
: abdominal aortic aneurysm
AAS
: acute aortic syndrome
ACC
: American College of Cardiology
ACE
: angiotensin-converting enzyme
AD
: Aortic dissection
ADAM
: Aneurysm Detection and Management
AHA
: American Heart Association
AJAX
: Amsterdam Acute Aneurysm
AO
: aorta
AOS
: aneurysms-osteoarthritis syndrome
ARCH
: Aortic Arch Related Cerebral Hazard
ATS
: arterial tortuosity syndrome
BAV
: bicuspid aortic valve
BSA
: body surface area
CI
: confidence interval
CoA
: coarctation of the aorta
CPG
: Committee for Practice Guidelines
CSF
: cerebrospinal fluid
CT
: computed tomography
DREAM
: Dutch Randomized Aneurysm Management
DUS
: Doppler ultrasound
EBCT
: electron beam computed tomography
ECG
: electrocardiogram
EDS
: Ehlers-Danlos syndrome
EDSIV
: Ehlers-Danlos syndrome type IV
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
EVAR
: endovascular aortic repair
FDG
: 18F-fluorodeoxyglucose
FL
: false lumen
GCA
: giant cell arteritis
GERAADA
: German Registry for Acute Aortic Dissection Type A
IAD
: iatrogenic aortic dissection
IMH
: intramural haematoma
INSTEAD
: Investigation of Stent Grafts in Patients with type B Aortic Dissection
IRAD
: International Registry of Aortic Dissection
IVUS
: intravascular ultrasound
LCC
: left coronary cusp
LDS
: Loeys-Dietz syndrome
MASS
: Multicentre Aneurysm Screening Study
MESA
: Multi-Ethnic Study of Atherosclerosis
MPR
: multiplanar reconstruction
MRA
: magnetic resonance angiography
MRI
: magnetic resonance imaging
MSCT
: multislice computed tomography
NA
: not applicable
NCC
: non-coronary cusp
ns-TAAD
: non-syndromic thoracic aortic aneurysms and dissection
OR
: odds ratio
OVER
: Open Versus Endovascular Repair
OxVasc
: Oxford Vascular study
PARTNER
: Placement of AoRtic TraNscathetER Valves
PAU
: penetrating aortic ulcer
PICSS
: Patent Foramen Ovale in Cryptogenic Stroke study
PET
: positron emission tomography
RCCA
: right common carotid artery
RCC
: right coronary cusp
RCT
: randomized, clinical trial
RR
: relative risk
SIRS
: systemic inflammatory response
SMC
: smooth muscle cell
TAA
: thoracic aortic aneurysm
TAAD
: thoracic aortic aneurysms and dissection
TAI
: traumatic aortic injury
TEVAR
: thoracic endovascular aortic repair
TGF
: transforming growth factor
TI
: separate thyroid artery (A. thyroidea)
TL
: true lumen
TOE
: transoesophageal echocardiography
TS
: Turner Syndrome
TTE
: transthoracic echocardiography
UKSAT
: UK Small Aneurysm Trial
ULP
: ulcer-like projection
WARSS
: Warfarin-Aspirin Recurrent Stroke Study

Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions …

/pdf/2014-esc-guidelines-on-the-diagnosis-and-treatment-of-aortic-23h9ibdx0k.pdf

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery.

Introduction: The purpose of this American Association for the Surgery of Trauma multicenter study is to assess the early efficacy and safety of endovascular stent grafts (SGs) in traumatic thoracic aortic injuries and compare outcomes with the standard operative repair (OR). Patients: Prospective, multicenter study. Data for the following were collected: age, blood pressure, and Glasgow Coma Scale (GCS) at admission, type of aortic injury, injury severity score, abbreviate injury scale (AIS), transfusions, survival, ventilator days, complications, and intensive care unit and hospital days. The outcomes between the two groups (open repair or SG) were compared, adjusting for presence of critical extrathoracic trauma (head, abdomen, or extremity AIS >3), GCS score ≤8, systolic blood pressure 55 years. Separate multivariable analysis was performed, one for patients without and one for patients with associated critical extrathoradc injuries (head, abdomen, or extremity AIS >3), to compare the outcomes of the two therapeutic modalities adjusting for hypotension, GCS score ≤8, and age >55 years. Results: One hundred ninety-three patients met the criteria for inclusion. Overall, 125 patients (64.9%) were selected for SG and 68 (352%) for OR. SG was selected in 71.6% of the 74 patients with major extrathoracic injuries and in 60.0% of the 115 patients with no major extrathoradc injuries. SG patients were significantly older than OR patients. Overall, 25 patients in the SG group (20.0%) developed 32 device-related complications. There were 18 endoleaks (14.4%), 6 of which needed open repair. Procedure-related paraplegia developed in 2.9% in the OR and 0.8% in the SG groups (p = 0.28). Multivariable analysis adjusting for severe extrathoradc injuries, hypotension, GCS, and age, showed that the SG group had a significantly lower mortality (adjusted odds ratio: 8.42; 95% CI: [2.76-25.69]; adjusted p value <0.001), and fewer blood transfusions (adjusted mean difference: 4.98; 95% CI: [0.14-9.82]; adjusted p value = 0.046) than the OR group. Among the 115 patients without major extrathoradc injuries, higher mortality and higher transfusion requirements were also found in the OR group (adjusted odds ratio for mortality: 13.08; 95% CI [2.53-67.53], adjusted p value = 0.002 and adjusted mean difference in transfusion units: 4.45; 95% CI [139-7.51]; adjusted p value = 0.004). Among the 74 patients with major extrathoracic injuries, significantly higher mortality and pneumonia rate were found in the OR group (adjusted p values 0.04 and 0.03, respectively). Multivariate analysis showed that centers with high volume of endovascular procedures had significantly fewer systemic complications (adjusted p value 0.001), fewer local complications (adjusted? value p = 0.033), and shorter hospital lengths of stay (adjusted p value 0.005) than low-volume centers. Conclusions: Most surgeons select SG for traumatic thoracic aortic ruptures, irrespective of associated injuries, injury severity, and age. SG is associated with significantly lower mortality and fewer blood transfusions, but there is a considerable risk of serious device-related complications. There is a major and urgent need for improvement of the available endovascular devices.

https://www.ubccriticalcaremedicine.ca/academic/jc_article/SG%20vs%20Open%20Thoracic%20Aorta%20(Apr-10-08).pdf

Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: Results of an American Association for the Surgery of Trauma multicenter study

Background:The diagnosis and management of blunt thoracic aortic injuries has undergone many significant changes over the last decade. The present study compares clinical practices and results between an earlier prospective multicenter study by the American Association for the Surgery of Trauma comp

Diagnosis and treatment of blunt thoracic aortic injuries: changing perspectives.

Background:The traditional approach to stable blunt thoracic aortic injuries (TAI) is immediate repair, with delayed repair reserved for patients with major associated injuries. In recent years, there has been a trend toward delayed repair, even in low-risk patients. This study evaluates the current

Valerie Malka

Papers

Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: Results of an American Association for the Surgery of Trauma multicenter study

Diagnosis and treatment of blunt thoracic aortic injuries: changing perspectives.

Blunt traumatic thoracic aortic injuries: early or delayed repair--results of an American Association for the Surgery of Trauma prospective study.