Targeted screening in families where there have been cases. Targeted interventions for men and women, also considering the size of the blood vessels. Interdisciplinary teams to offer the best in surgery and situation monitoring. And, above all, the patient who is the protagonist of the therapeutic choice on the operating bed. In this way we will always better face the potential “time bomb” represented by thethoracic aortic aneurysm and aortic dissection.
These lesions develop over time and then appear sometimes suddenly, perhaps following a hypertensive episode, putting the life of those who have these changes in the arterial wall at risk. The American College of Cardiology and the American Heart Association present on Journal of American College of Cardiology e Circulation the new guidelines created by a team of experts coordinated by Eric M. Isselbacherfor the early diagnosis and treatment of these pathologies, focusing above all on the importance of suspecting and discovering the lesions through specific tests, in order to then be able to intervene in the best way, case by case.
What are aneurysms and aortic dissection
The thoracic aorta is the part of the vessel closest to the heart. Aneurysm is a subtle and potentially fatal disease, with just under 2000 cases a year in Italy. The problem is related to a dilation of the main artery near the heart – which carries about 200 million liters of blood over an average life span and is 3 centimeters in diameter. When the aneurysm occurs, a sort of “bubble”, the diameter of the vessel becomes thin even if in almost all cases you don’t even notice what happens.
The lesion affects men more than women, with a ratio of three to one, and the age group between 55 and 75 years. The main causes are congenital in nature – linked to diseases that weaken or alter the walls of the aorta such as Marfan’s syndrome, or arteriosclerosis. But traumas resulting from violent rear-end collisions that cause the aorta to tear can also be important.
Smoking, hypertension, and family history are key risk factors for aortic aneurysm. Aortic dissection, on the other hand, begins acutely with the slipping of the aortic walls. Depending on the portion of the vessel affected and its extension, it can have a very high mortality.
Heart door
Aortic aneurysm, genes (also) count
by Federico Mereta
It is important to study families
First of all, from a preventive point of view, attention is focused on the need to identify those at greater risk of developing diseases of the aorta. For this reason, attention must be focused on families in which cases have already occurred. Family screening should include both targeted genetic testing and radiological examinations, studying all first-degree relatives of individuals diagnosed with aortic root aneurysm or ascending thoracic aorta, or those with aortic dissection. It also reminds us how important it is to carry out exams such as CT scan or magnetic resonance imaging in a single center or in any case following the same technique.
Tailor-made interventions
The new guidelines recommend planning any interventions also based on the physical structure of the patients, especially if they are very small or high compared to the average. For the rest, in specialized centers the threshold for surgery for sporadic aneurysms of the aortic root and ascending aorta has been lowered from 5.5 to 5 centimeters in some individuals, recalling that the risk of aneurysm or aortic dissection increases with The dimensions.
With this recommendation, select individuals can undergo lifesaving surgery earlier to prevent death from aneurysm or aortic dissection. Additionally, the guidelines update the definition of rapid aneurysm growth rate: surgery is recommended for people with aortic root and ascending thoracic aortic aneurysms with a confirmed growth rate of 0.3 or greater. centimeters per year for two consecutive years or 0.5 centimeters per year. Rapid growth of the aorta is a risk factor for rupture.
Not just a scalpel for abdominal aortic aneurysm
The patient is the protagonist of the choice of treatment
“The guidelines place great importance on the experience of the centers, which must be equipped with multidisciplinary teams that necessarily include cardiac surgeons, vascular and endovascular surgeons and anesthetists expert in aortic treatments, but above all on ‘decision sharing’ – he comments Mauro Rinaldi, Professor of Cardiac Surgery at the University of Turin. It is essential to involve the patient in fundamental choices, especially when there is no clear evidence of the benefit of one treatment over another: for example, this aspect must be considered in the treatment of asymptomatic B-dissections or the need for intervention in dilated aortas in genetic syndromes. for women before pregnancy “.
For the rest, according to the experts, the decrease of the threshold from 5.5 to 5 centimeters for the ascending aorta had been expected for some time and already several specialists were moving in this direction. “The indication of a thoracic aortic threshold diameter of 5.5 cm in the case of a descending thoracic aneurysm (instead of the 6 cm of other guidelines) and the reduction of the cut-off aortic diameter for the surgical indication in expert centers for other pathologies – concludes Rinaldi. Unfortunately many of the recommendations are not based on studies with high level evidence but on the recommendation of experts so there is a great need for prospective and randomized studies (RCT) that confirm the one established by the current guidelines “.
Closer to the biotech artery for very small coronaries