Chavan Ajay, Rosenthal Herbert, Luthe Lars, Pfingsten Stefanie, Kutschka Ingo, Easo Jerry, Piepenbrock Siegfried, Dapunt Otto, Haverich Axel, Galanski Michael
Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg, Rahel Straus Str. 10, 26133 Oldenburg, Germany.
Eur Radiol. 2009 Feb;19(2):488-94. doi: 10.1007/s00330-008-1141-4. Epub 2008 Aug 9.
The aim of this study was to evaluate the role of percutaneous interventions in treating ischemia complicating aortic dissection. Forty-five patients with ischemia complicating aortic dissection were treated by balloon fenestration, true lumen stenting, angioplasty, or thrombolysis. Clinical and laboratory examinations were performed before and after intervention, and at the end of follow-up (median 37 months). Eighteen dissections were acute, 9 sub-acute, and 18 chronic. Mesenterohepatic ischemia resolved in 16 of 18 patients; lactate and SGOT values fell from 2.89 to 1.23 mmol/L (p=0.006) and from 165.9 to 59.7 U/L (p=0.034), respectively. In patients with renal ischemia, creatinine levels fell from 360.1 to 196.3 micromol/L (p=0.007) accompanied by a significant reduction in blood pressure. Limb-threatening ischemia resolved in three of four patients; in 21 claudicants, the mean walking distance improved from 272 to 1,283 m (p=0.001). Spinal ischemia resolved completely or partially in six of eight patients. Adjunctive surgical measures were necessary in six patients. Overall 30-day mortality in the 45 patients was 6.7%; all three deaths were in patients with acute dissections (mortality in this subgroup 16.7%). Ischemia complicating aortic dissection can be effectively treated by percutaneous interventions resulting in good early and mid-term outcomes.
本研究的目的是评估经皮介入治疗主动脉夹层并发缺血的作用。45例主动脉夹层并发缺血的患者接受了球囊开窗、真腔支架置入、血管成形术或溶栓治疗。在干预前后以及随访结束时（中位时间37个月）进行临床和实验室检查。18例夹层为急性，9例为亚急性，18例为慢性。18例肠系膜肝缺血患者中16例症状缓解；乳酸和谷草转氨酶值分别从2.89 mmol/L降至1.23 mmol/L（p=0.006），从165.9 U/L降至59.7 U/L（p=0.034）。肾缺血患者的肌酐水平从360.1 μmol/L降至196.3 μmol/L（p=0.007），同时血压显著降低。4例肢体威胁性缺血患者中有3例症状缓解；21例间歇性跛行患者的平均步行距离从272米提高到1283米（p=0.001）。8例脊髓缺血患者中有6例完全或部分缓解。6例患者需要辅助手术措施。45例患者的30天总死亡率为6.7%；所有3例死亡患者均为急性夹层患者（该亚组死亡率为16.7%）。经皮介入治疗可有效治疗主动脉夹层并发的缺血，早期和中期效果良好。
