Utility of guidelines for the treatment of ascending aortic aneurysms: A medical strategy analysis

Utility of guidelines for the treatment of ascending aortic aneurysms:
A medical strategy analysis

Yskert von Kodolitsch; Alexander M. Bernhardt; Tilo Kölbel; Stefan Blankenberg; Hermann Reichenspurner; Sebastian Debus; Christian Detter

University Heart Center at the University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

Abstract

Objective. Highly lethal acute aortic syndromes comprise aortic dissection, intramural hematoma, penetrating aortic ulcer and direct aortic rupture. Such pathologies develop silently as they progress from dilatation to aneurysm to finally result in acute aortic syndrome. The goals of therapy are to prevent aortic dilatation, to slower growth of dilatation to aneurysm, and to prevent aneurysm to evolve into acute thoracic aortic syndromes. Methods. We perform a medical strategy analysis to assess the utility of the guideline of the European Society of Cardiology to support physicians to maximize success in the treatment of ascending aortic aneurysms. Results. We present a three-stage complexity reduction model of standardized treatment recommendations. Stage-1 reduction identifies the reduction of a complex clinical reality to a guideline recommendation. Stage-2 reduction takes place when individual physicians execute a recommendation in a standardized manner irrespective of their own conviction, judgement and capability and irrespective of the inherent limitations of each therapeutic option. Stage-3 reduction identifies a therapy that is applied to individual patients without considering their physical, normative and psychological individuality. Therefore, to avoid failure of treatment, guideline recommendations require adjunctive procedures to translate standardized recommendations into individualized therapies. We introduce ISWOT is an instrument to match out an optimal medical strategy for each individual patient. Conclusions. Medical strategy analysis documents the utility of the ESC guideline to maximize success of therapy of ascending aortic aneurysm. However, major adjustments are usually needed to match out an optimal medical strategy for each individual patient.

Key words: Aortic Rupture; Individuality; Aorta; Thoracic; Aortic Aneurysm; Hematoma.