Singh Robert S, Danikas Dimitrios, Goldenkranz Robert
Department of Vascular Surgery, Beth Israel Medical Center, Newark, New Jersey, USA.
Am Surg. 2002 Jan;68(1):49-51.
Type B aortic dissection involves the appearance of a false lumen distal to the left subclavian artery and extending distally into the descending thoracic aorta and into the abdominal aorta. Complications of the dissection include rupture of the thoracic aorta, leg ischemia, visceral ischemia, and renal failure. A 37-year-old man presented with complaints of sudden onset of chest pain, left leg pain, and numbness. Examination revealed no femoral, popliteal, or distal pulses with decreased sensory and motor function on the left lower extremity. A CT scan revealed an aortic dissection at the proximal descending aorta extending into the iliac arteries with a left retroperitoneal hematoma at the iliac bifurcation. An MRI confirmed the dissection distal to the left subclavian artery into the iliac artery with a distal occlusion. Exploration revealed rupture of the left iliac artery dissection with arterial occlusion and a contained hematoma. The common iliac artery was ligated and an 8-mm Dacron bypass graft from the right common femoral artery to the left femoral artery was performed. Type B aortic dissection can present as rupture of the common iliac artery. Revascularization of the extremity with a femoral-femoral crossover graft is the recommended procedure in the absence of visceral ischemia. The surgeon should have a keen suspicion of this rare complication and its management.
B型主动脉夹层是指在左锁骨下动脉远端出现假腔，并向远端延伸至胸降主动脉和腹主动脉。夹层的并发症包括胸主动脉破裂、腿部缺血、内脏缺血和肾衰竭。一名37岁男性因突发胸痛、左腿疼痛和麻木前来就诊。检查发现左侧下肢股动脉、腘动脉或远端脉搏消失，感觉和运动功能减退。CT扫描显示降主动脉近端有主动脉夹层，延伸至髂动脉，髂动脉分叉处有左腹膜后血肿。MRI证实左锁骨下动脉远端至髂动脉有夹层伴远端闭塞。手术探查发现左髂动脉夹层破裂伴动脉闭塞及包裹性血肿。结扎了髂总动脉，并进行了从右股总动脉到左股动脉的8毫米涤纶搭桥移植术。B型主动脉夹层可表现为髂总动脉破裂。在没有内脏缺血的情况下，采用股-股交叉移植术对肢体进行血运重建是推荐的手术方法。外科医生应高度怀疑这种罕见的并发症及其处理方法。
