Starnes Benjamin W, O'Donnell Sean D, Gillespie David L, Goff James M, Rosa Patricio, Rich Norman M
Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
Ann Vasc Surg. 2002 May;16(3):368-74. doi: 10.1007/s10016-001-0184-7. Epub 2002 Apr 18.
We report the endovascular management of a patient with a type B aortic dissection complicated by renal ischemia and resultant severe hypertension. A 69-year-old male presented with acute type B aortic dissection with proximal extension complicated by severe renovascular hypertension secondary to left renal ischemia. Endovascular management consisted of imaging with intravascular ultrasound and left renal artery stenting with balloon-expandable stents. His hypertension subsequently resolved and he was discharged on his baseline two-drug regimen. Management of the ischemic complications of type B aortic dissections may be primarily approached using endovascular methods in stable patients, with open surgery reserved for those patients refractory to these methods. Patients with evidence of decreased renal perfusion represent a select group with an increased risk of associated morbidity and mortality and should therefore be aggressively managed. Accurate information and assessment of anatomy can be obtained with intravascular ultrasound and is therefore an important adjunct to the armamentarium of endovascular specialists managing complications of aortic dissection.
我们报告了1例B型主动脉夹层并发肾缺血及由此导致的严重高血压患者的血管内治疗情况。一名69岁男性因急性B型主动脉夹层伴近端扩展，并发左肾缺血继发的严重肾血管性高血压。血管内治疗包括血管内超声成像以及使用球囊扩张支架行左肾动脉支架置入术。其高血压随后得到缓解，出院时继续使用基线期的两药联合治疗方案。对于病情稳定的B型主动脉夹层缺血性并发症患者，可首先采用血管内方法进行治疗，而对于那些对这些方法无效的患者则保留开放手术治疗。有肾灌注减少证据的患者属于特定人群，其相关发病率和死亡率风险增加，因此应积极治疗。血管内超声可获取准确的解剖信息和评估结果，因此是血管内专家处理主动脉夹层并发症的重要辅助手段。
