Aortic disease and peripheral artery disease

The Annual Report on Cardiovascular Health and Diseases in China (2022) intricate landscape of car-diovascular health in China. In connection with the previous section, this 10^th section of the report offers a comprehensive analysis of aortic disease and peripheral artery disease. Aortic dissection is a critical disease, with a higher incidence in men than in women. The main risk factors include hypertension, gene mutations, and so on. Recent studies suggest that young patients with aortic dissection have a higher body mass index, and there is a significant correlation between low ambient temperature and sudden temperature drop and the onset of dissection. The main hazards are aortic rupture or poor branch perfusion, which is life threatening. According to the lesion location, it is divided into Stanford A type (involving the ascending aorta) and Stanford B type (not involving the ascending aorta). The treatment of type A dissection is mainly open surgery, while the treatment of type B dissection is preferably endovascular treatment. In recent years, with the continuous development of endovascular technique, the treatment of aortic arch lesions has transformed gradually from open to hybrid, and then to total endovascular treatment. The prevalence of abdominal aortic aneurysm is relatively low (< 1%), and its risk factors mainly include smoking, hypertension, dyslipidemia, etc. The main hazard is the rupture of the aneurysm leading to death. Currently, treatment methods include endovascular repair and open surgery. According to data from Hospital Quality Monitoring System (HQMS), in the past five years, the number of open and endovascular operations for aortic disease in China has shown an upward trend, which may be due to the popularization of diagnostic and therapeutic techniques and increased attention to aortic disease. The in-hospital mortality rates of thoracic endovascular aortic repair, endovascular aortic repair, and Bentall operations are relatively low (all < 2%). Due to the complexity and difficulty of the operation, the in-hospital mortality of total arch replacement is 5.9%–7.4%. Overall, the in-hospital mortality decreased while the number of surgeries increased. This section also elaborates on the five peripheral artery diseases (PADs): lower extremity artery disease (LEAD), carotid atherosclerotic disease, subclavian artery stenosis, mesenteric artery disease and renal artery stenosis, from the perspectives of epidemiology, risk factors, evaluation methods, diagnosis, and treatment. PAD is common among middle-aged and elderly people, and is significantly related to the risk factors of cardiovascular disease. Diagnosis and treatment methods are constantly being improved and updated. Besides traditional evaluation methods, artificial intelligence, molecular biology and other methods have been continuously developed, improving diagnostic sensitivity and specificity. Treatment methods include risk factor control, medication, revascularization (percutaneous endovascular intervention and surgical treatment), and exercise etc. New treatment methods such as cell engineering and xenogeneic vascular graft have also shown promise in the treatment of LEAD.