Descending thoracic aortic aneurysms (DTAA) have always represented a challenge for the vascular surgeon, despite their incidence is lower compared to abdominal aortic aneurysms. Endovascular repair (ER) has noticeably improved the outcomes of treatment, and it is now considered the "gold standard" even in urgent situations. Yet, open repair is still reserved to selected cases, such as connective tissue disorders, aortic anatomies not suitable for ER, and large aneurysms compressing neighboring organs. Therefore the knowledge of surgical techniques should still belong to every vascular surgeon's arsenal. The aim of this chapter is to summarize the current knowledge on DTAA, from epidemiology to treatment, providing a description of surgical and endovascular procedures and their related results.
Acute limb ischemia (ALI) is characterized by a sudden decrease or interruption of arterial blood flow in limb arteries. It is one of the most common emergencies in vascular surgery and interventional radiology because there is insufficient time for vascular angiogenesis to compensate the loss of perfusion. The reported incidence of ALI is approximately 1.9 cases per 10,000 individuals per year. Complications in ALI patients are high, even after surgical and/or endovascular treatment, with an amputation rate ranging from 10% to 30% and a risk of mortality approximately 15%–20% within the first year, due to comorbidities. ALI etiologies are due to three main causes: embolism, thrombosis, and vessel trauma with a thrombosis to embolism ratio of about 9:1. A peculiar picture of ALI is the thrombosis of popliteal aneurysm that requires a specific diagnostic and therapeutic approach. Lastly, the compartmental syndrome of the limbs is a complication that should be always taken into account after a revascularization of an ALI.
Understanding the molecular and cellular mechanisms at the basis of every disease is fundamental in modern medicine. Each vascular condition is caused by molecular events occurring in the cellular components of the blood vessel wall.
