Frahm Christian, Widmer Matthias K, Brossmann Joachim, Do Dai-Do
Department of Diagnostic Radiology, University Hospital Kiel, Arnold-Heller-Strasse 9, D-24105 Kiel, Germany.
Cardiovasc Intervent Radiol. 2002 Sep-Oct;25(5):444-6. doi: 10.1007/s00270-002-1918-9. Epub 2002 Mar 27.
We report a case of aorto-iliac occlusion due to descending aortic dissection treated initially with femoro-femoral cross-over bypass and secondarily with unilateral aorto-iliac stenting because of progression of the dissection. A 75-year-old man presented with acute ischemia of the right leg. CT revealed occlusion of the right iliac artery due to descending aortic dissection with a clotted false lumen. Three days after femoro-femoral cross-over bypass, ischemia of both legs developed and angiography demonstrated occlusion of the infrarenal aorta and left common iliac artery. Two overlapping stents were deployed in these vessel segments. Completion angiography confirmed successful recanalization with adequate distal flow and good patency of the cross-over bypass. Peripheral pulses were restored and the patient's symptoms were alleviated. Combined treatment with cross-over bypass and endovascular recanalization may be considered as a viable alternative to open aortic surgery in selected cases of complicated aorto-iliac dissection with bilateral leg ischemia.
我们报告一例因降主动脉夹层导致的主-髂动脉闭塞病例，最初采用股-股交叉旁路手术治疗，后因夹层进展而采用单侧主-髂动脉支架置入术。一名75岁男性因右腿急性缺血就诊。CT显示降主动脉夹层导致右髂动脉闭塞，假腔内有血栓形成。股-股交叉旁路手术后三天，双腿出现缺血，血管造影显示肾下腹主动脉和左髂总动脉闭塞。在这些血管段置入了两个重叠支架。完成血管造影证实成功再通，远端血流充足，交叉旁路通畅良好。外周脉搏恢复，患者症状缓解。对于伴有双侧腿部缺血的复杂主-髂动脉夹层的特定病例，交叉旁路手术和血管内再通联合治疗可被视为开放主动脉手术的可行替代方案。
