A quarter of a century ago, patients with aortic aneurysms and dissections that were beyond the scope of medical or conservative management were treated exclusively with open surgery. Less invasive endoluminal management has developed rapidly over the past two and a half decades, thus changing the treatment algorithm in these patients. Today the focus has shifted to primary management with a combination of endoluminal intervention and optimal medical treatment of aortic disease distal to the origin of the left subclavian artery. Interventional in-roads are being made into the territory of the aortic arch as well.
As Guest Editor of CVIR, it gives me great pleasure to present to you a special issue dedicated to aortic interventions, which has been in the making for more than 12 months. The issue is structured to separately address endoluminal treatment of the aortic arch and of various aortic segments further distally. In addition, one article separately deals with state-of-the-art imaging that is essential for aortic intervention. A dedicated article on secondary endoleak management elaborates upon how to deal with this intriguing post-procedural dilemma. To round up the issue, the last article deals with open surgical options in case endoluminal therapy fails.
The issue contains articles that deal with aortic aneurysms and dissections as well as with inflammatory aortic disease, written by renowned authorities in the field, across the globe. The articles are structured broadly according to a uniform format. After presenting technical details and indications for intervention, they present results in the current literature regarding clinical (e.g. rupture, branch vessel ischaemia) as well as morphological response (e.g. aneurysm shrinkage and aortic remodelling), morbidity and mortality associated with endoluminal aortic intervention. Furthermore, a “Fact-sheet” in each article succinctly provides the most important points, numbers, literature, messages and future predictions with respect to the topic addressed in the article.
The aim of the articles is to provide the reader with a state-of-the-art overview of the topic. In addition to getting familiar with the basic technique as well as with recent technical advances, the reader will be able to gather a synopsis of the results in the literature with respect to technical and clinical outcome. Should she or he desire more detailed information, obtaining this would be easily possible by referring to the cited literature. A major goal of the issue will have been achieved if, after going through it, the interdisciplinarity necessary for optimally managing aortic disease becomes apparent to the reader.
I hope you enjoy partaking of the issue!
Prof. Dr. med. Ajay Chavan
This study was not supported by any funding.
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Chavan, A. Introduction to the CVIR Special Section on Aorta. Cardiovasc Intervent Radiol 43, 1743–1744 (2020). https://doi.org/10.1007/s00270-020-02633-z