Tefera Girma, Carr Sandra, Hoch John, Acher Charles W, Turnipseed William D
University of Wisconsin Hospital & Clinics, Madison, Wisconsin, USA.
J Endovasc Ther. 2002 Oct;9(5):579-82. doi: 10.1177/152660280200900504.
To report a challenging case of infrarenal abdominal aortic aneurysm (AAA) treated with a commercial stent-graft in the face of thoracoabdominal aortic dissection.
A 73-year-old patient was admitted because of acute descending thoracic and abdominal aortic dissection. He was also found to have an 8-cm infrarenal AAA. After initial medical management of the acute aortic dissection, the patient underwent endoluminal AAA repair with an AneuRx stent-graft. The completion angiogram showed that the graft was deployed in the false lumen; this complication was treated with fenestration of the intimal flap, establishing flow through both lumens. The patient's recovery was uneventful, and he was discharged on the fourth postoperative day. Follow-up at 1 year with computed tomographic angiography documented a stable descending thoracic aorta with a suggestion of a type II endoleak and no change in the aneurysm volume.
This case illustrates the feasibility of endograft repair of infrarenal AAA with a modular stent-graft in the presence of aortic dissection extending below the renal arteries.
报告一例具有挑战性的肾下腹主动脉瘤（AAA）病例，该病例在存在胸腹主动脉夹层的情况下采用商用覆膜支架进行治疗。
一名73岁患者因急性降主动脉胸段和腹段夹层入院。还发现其患有一个8厘米的肾下腹主动脉瘤。在对急性主动脉夹层进行初步药物治疗后，患者接受了使用AneuRx覆膜支架的腔内腹主动脉瘤修复术。完成血管造影显示移植物被植入假腔；通过内膜瓣开窗术治疗了这一并发症，使血流通过两个腔隙。患者恢复顺利，术后第四天出院。术后1年的计算机断层血管造影随访显示降主动脉稳定，提示存在II型内漏，且动脉瘤体积无变化。
本病例说明了在肾动脉以下存在主动脉夹层的情况下，使用模块化覆膜支架进行肾下腹主动脉瘤腔内修复的可行性。
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