Murphy T P, Dorfman G S, Segall M, Carney W I
Department of Diagnostic Imaging, Rhode Island Hospital, Providence 02903.
Cardiovasc Intervent Radiol. 1991 Sep-Oct;14(5):302-6. doi: 10.1007/BF02578455.
Iatrogenic arterial dissection may require intervention, depending on the severity of resulting stenosis and the degree of symptoms. We present 5 cases of iatrogenic arterial dissection: 1 with dissection of the lower abdominal aorta, common iliac artery, and external iliac artery, and 3 with external iliac artery dissections, all managed with percutaneous transfemoral transluminal angioplasty; and 1 with dissection of the superior mesenteric artery with angioplasty performed by the translumbar approach. Four of the 5 patients had no additional therapy; 1 patient eventually underwent surgery for an asymptomatic residual pseudoaneurysm seen on abdominal computed tomography. Angiographic follow-up in 2 patients demonstrated persistent improvement in stenosis, 1 at 2 weeks after angioplasty, and the other, 6 weeks following angioplasty. None of the 5 patients required further therapy for recurrence of symptoms on clinical follow-up obtained up to 1 year after angioplasty. Though the incidence of recurrent arterial stenosis following angioplasty for dissection may be greater than that incurred after intravascular stent placement or surgery, angioplasty may be effective, and has the advantage of being less expensive than both of these treatment modalities, and more widely available and applicable than intravascular stents.
医源性动脉夹层可能需要干预，这取决于所导致狭窄的严重程度和症状的程度。我们报告5例医源性动脉夹层病例：1例为下腹主动脉、髂总动脉和髂外动脉夹层，3例为髂外动脉夹层，均采用经皮股动脉腔内血管成形术治疗；1例为肠系膜上动脉夹层，采用经腰途径进行血管成形术。5例患者中有4例未接受其他治疗；1例患者最终因腹部计算机断层扫描发现无症状残留假性动脉瘤而接受手术。2例患者的血管造影随访显示狭窄持续改善，1例在血管成形术后2周，另1例在血管成形术后6周。在血管成形术后长达1年的临床随访中，5例患者均无需因症状复发而接受进一步治疗。尽管夹层血管成形术后动脉再狭窄的发生率可能高于血管内支架置入或手术后的发生率，但血管成形术可能有效，并且具有比这两种治疗方式成本更低、比血管内支架更广泛可用和适用的优点。
