Fujita Wakako, Daitoku Kazuyuki, Taniguchi Satoshi, Fukuda Ikuo
Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki city, Aomori, Japan.
Interact Cardiovasc Thorac Surg. 2009 Feb;8(2):266-8. doi: 10.1510/icvts.2008.191361. Epub 2008 Nov 14.
Acute aortic dissection frequently causes life-threatening organ ischemia. The optimal therapy for acute type-B aortic dissection is still controversial. Early surgery for acute dissections with organ malperfusion is known to carry a high morbidity and mortality. Endovascular treatment, such as stent placement for branch stenosis, percutaneous balloon fenestration for compression of the true channel and aortic stent placement to support collapsed true channel, is becoming an alternative form of treatment. However, it is not clear whether endovascular intervention alone is effective in the long term. We herein report a case of emergency percutaneous endovascular stenting with intentional surgical delay in a patient who had visceral and lower extremity malperfusion due to acute type-B dissection. A 10x57 mm bare metal stent was inserted into the obliterated true channel of the thoracoabdominal aorta 3 h after onset of symptoms. It immediately relieved the abdominal and lower limb ischemic symptoms. The advantage of small-sized stent placement is its easiness and being gentle to fragile intima. The small-sized stent placement for patients with acute aortic dissection with visceral organ ischemia may be a promising 'bridging therapy' before they undergo traditional central repair.
急性主动脉夹层常导致危及生命的器官缺血。急性B型主动脉夹层的最佳治疗方法仍存在争议。已知对伴有器官灌注不良的急性夹层进行早期手术具有较高的发病率和死亡率。血管内治疗，如针对分支狭窄的支架置入、针对真腔受压的经皮球囊开窗术以及用于支撑塌陷真腔的主动脉支架置入术，正成为一种替代治疗方式。然而，单纯血管内干预的长期效果尚不清楚。我们在此报告一例因急性B型夹层导致内脏和下肢灌注不良的患者，在紧急情况下进行经皮血管内支架置入并有意延迟手术的病例。症状出现3小时后，将一枚10×57毫米的裸金属支架置入胸腹主动脉闭塞的真腔。它立即缓解了腹部和下肢的缺血症状。小型支架置入的优点是操作简便且对脆弱内膜损伤较小。对于伴有内脏器官缺血的急性主动脉夹层患者，小型支架置入可能是一种有前景的在接受传统中心修复之前的“桥接治疗”。
