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An assessment of the current medical management of thoracic aortic disease: A patient-centered scoping literature review

Authors :
Robert C.F. Pena
Marion A. Hofmann Bowman
Myra Ahmad
Julie Pham
Eva Kline-Rogers
Melanie J. Case
Jenney Lee
Kim Eagle
Novelett E. Cotter
Carmen C. David
Mark Fasano
Richard Goldenberg
Jake Howitt
Timo T. Söderlund
Debra Trotter
Asaf Rabin
Mattie Boehler-Tatman
Melissa L. Russo
Laura Marie Drudi
Laura L. Marks
Maisoon D. Yousif
Tabea Hoffstaetter
Ella Taubenfeld
Sreekanth Vemulapalli
Chrisanne S. Campos
Lindsey Rusche
Firas F. Mussa
Gretchen MacCarrick
Earl Goldsborough
Christeen Samuel
Lillian Xu
Nicolas J. Mouawad
Eanas S. Yassa
Xiaoyi Teng
Amani Politano
Jesse Teindl
Lara Bloom
Rebecca Gluck
Meredith Ford O'Neal
Josephine Grima
Eileen Masciale
Takeyoshi Ota
Katelyn Wright
Alan J. Hakim
Gareth Owens
George J. Arnaoutakis
Dejah Judelson
Mario D'Oria
Lurdes del Rio-Sola
Mark Ajalat
Marvin Chau
Stephanie D. Talutis
Karen Woo
Max V. Wohlauer
Jeniann A. Yi
Kim A. Eagle
Hyein Kim
Claudine Henoud
Scott Damrauer
Emilia Krol
Rana O. Afifi
Alana C. Cecchi
Madeline Drake
Anthony Estrera
Avery M Hebert
Dianna M. Milewicz
Siddharth K. Prakash
Aaron W. Roberts
Harleen Sandhu
Akili Smith-Washington
Akiko Tanaka
Jacob Watson
Catherine M. Albright
Christopher R. Burke
Peter H. Byers
L'Oreal Kennedy
Sarah O. Lawrence
Jenney R. Lee
Jonathan Medina
Thamanna Nishath
Courtney Segal
Sherene Shalhub
Michael Soto
Linell Catalan
Megan Patterson
Nicole Ilonzo
Source :
Seminars in Vascular Surgery. 35:16-34
Publication Year :
2022
Publisher :
Elsevier BV, 2022.

Abstract

Thoracic aortic aneurysm and dissection are complex diagnoses that require management by multidisciplinary providers using a variety of medical therapies, surgical interventions, and lifestyle modifications. Pharmacological agents, such as β-blockers (atenolol) and angiotensin II type 1 receptor blockers (losartan), have been mainstay treatments for several years, and research from the past decade has continued to evaluate these and other medication classes to further improve patient morbidity and mortality. Combination β- and renin-aldosterone-angiotensin blockade, statins, metformin, antioxidants, and vitamins have been evaluated as therapeutics in both thoracic and abdominal aortic aneurysms, as well as the effects of various antibiotics (ie, fluoroquinolones and tetracyclines) and benefits of lifestyle modifications (eg, diet and exercise) and enhanced patient-centered care and treatment adherence. In addition, as our understanding of the genetic, biochemical, and pathophysiological mechanisms behind these diseases expands, so do potential targets for future therapeutic research (eg, interleukins, matrix metalloproteases, and mast cells). This review incorporates the major meta-analyses, systematic and generalized reviews, and clinical trials published from 2010 through 2021 that focus on these topics in thoracic aortic aneurysms (and abdominal aneurysms when thoracic literature is scarce). Several key ongoing clinical trials, case studies, and in vivo/in vitro studies are also mentioned. Furthermore, we discuss current gaps in the literature and the abundance of clinical evidence for some interventions in abdominal aneurysms with few thoracic correlates, thus indicating a need for investigation of these subjects in the latter.

Details

ISSN :
08957967
Volume :
35
Database :
OpenAIRE
Journal :
Seminars in Vascular Surgery
Accession number :
edsair.doi.dedup.....3ac464a99f8688931deda71a6e75c149