**Improvements in the Endovascular and Surgical Management of Aortic Disease**

78 Aneurysmal Disease of the Thoracic and Abdominal Aorta

[56] Levin, D.C., Rao, V.M., Parker, L., Frangos, A.J. & Sunshine, J.H. Endovascular repair

[57] Wanhainen, A., Bylund, N. & Bjorck, M. Outcome after abdominal aortic aneurysm

[58] Fleming, C., Whitlock, E.P., Beil, T.L. & Lederle, F.A. Screening for abdominal aortic

trends from 2001 to 2006. *J Am Coll Radiol* 6, 506-509 (2009).

repair in Sweden 1994-2005. *Br J Surg* 95, 564-570 (2008).

Force. *Ann Intern Med* 142, 203-211 (2005).

vs open surgical repair of abdominal aortic aneurysms: comparative utilization

aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task

**4** 

*1Sweden 2Italy* 

**Alternative Surgical Management of** 

*1Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg* 

The standard treatment for an ascending aorta aneurysm is radical resection and

Involvement of other adjacent structures has dictated the employment of more complex surgical techniques. The surgical treatment of concomitant disease of the aortic valve, aortic root and ascending aorta started in 1968 with Bentall and De Bono (Bentall & De Bono, 1968), who applied a new surgical technique bearing their names and that represents the standard surgical technique for this pathology. With this technique, the valve, aortic root and ascending aorta are resected, replaced with a prosthetic valvular conduit, and the coronary vessels are anastomised to the tubular prosthesis. Nowadays, this represents a widely accepted surgical strategy to treat concomitant disease at the three mentioned structures. Minimally invasive procedures have been reported in the treatment of these

In contrast, treatment of moderate ascending aorta dilatation associated with aortic valvular disease and with or without mild involvement of the aortic root is still controversial, especially in high risk patients (Bahnson, 1982; Prenger et al., 1994; Svensson et al., 1992). While it is usually accepted that ascending aorta dilatation beyond 5 cm should be surgically replaced, opinions on the treatment below this limit are divided (Ergin et al., 1999). In older and high surgical risk patients, several conservative surgical techniques on the ascending aorta have been proposed, such as the "waistcoat" aortoplasty, the simple aortoplasty, the "S" shape aortoplasty and the "wrap" aortoplasty (Robicsek & Thubrikar, 1994; Mueller et al., 1997). Radical resection of the ascending aortic aneurysm is needed in order to eliminate all the pathologic tissue of the aorta damaged by degenerative processes, such as cystic medionecrosis, aterosclerosis, and inflammatory processes. Lack of resecting part of the

In the presence of mild to moderate dilatation of the ascending aorta associated with aortic valve disease, it may be difficult to ascertain if the dilatation is secondary to the hemodynamic alterations produced by the valvulopathy or by a disease of the aortic wall.

**1. Introduction** 

interposition of a tubular prosthesis.

patients as well (Perrotta et al., 2008; Perrotta & Lentini, 2009).

degenerative tissue may predispose to new aneurysmatic dilatation.

**2. Histology and pathophisiology in aortic aneurysms** 

*2Department of Cardiothoracic Surgery, University Hospital "G Martino",* 

**Ascending Aorta Aneurysm** 

Sossio Perrotta1 and Salvatore Lentini2

*University of Messina, Messina* 
