Department of Surgical Sciences - Vascular Surgery, Varese University Hospital - University of Insubria, Varese, Italy.
J Vasc Surg. 2010 Apr;51(4):993-9. doi: 10.1016/j.jvs.2009.10.105.
Endovascular intervention has emerged as a less traumatic alternative treatment for several diseases of the thoracic aorta.(1,2) However, depending on the different aortic pathologies, procedure related complications have become increasingly evident: severe complications include type I endoleaks, migration, and endograft (EG) collapse, as well as those observed during conventional surgery (eg, stroke and paraplegia).(3,4) One of the emerging and most alarming complication of thoracic endografting is iatrogenic retrograde type A acute dissection (RTAAD).(5) Retrograde type A acute dissection is defined as acute aortic dissection that originates distally to the ascending aorta with a retrograde flap progression into the ascending aorta.(6) This complication has been previously described during conventional cardiac surgery with high mortality rate; previous case reports suggested that the fragility of the aortic wall and Marfan disease were predisposing factors to such a life-threatening complication.(7-9) This report presents a case of iatrogenic RTAAD after EG repair of a descending thoracic penetrating aortic ulcer, requiring emergent surgical replacement of the ascending aorta and the aortic arch. The available English literature on RTAAD was also reviewed, in order to recognize potential predisposing factors and specific strategies to prevent it.
血管内介入治疗已成为治疗胸主动脉多种疾病的一种创伤较小的替代治疗方法。(1,2) 然而，根据不同的主动脉病变，与手术相关的并发症越来越明显：严重的并发症包括 I 型内漏、迁移和移植物（EG）塌陷，以及在传统手术中观察到的并发症（如中风和截瘫）。(3,4) 胸主动脉腔内修复术的一个新出现的、最令人担忧的并发症是医源性逆行性 A 型急性夹层（RTAAD）。(5) 逆行性 A 型急性夹层是指起源于升主动脉远端的急性主动脉夹层，逆行瓣片向升主动脉进展。(6) 这种并发症以前在传统心脏手术中已有描述，死亡率很高；以前的病例报告表明，主动脉壁脆弱和马凡综合征是这种危及生命的并发症的易患因素。(7-9) 本报告介绍了一例 EG 修复降胸穿透性主动脉溃疡后发生的医源性 RTAAD，需要紧急手术替换升主动脉和主动脉弓。还回顾了关于 RTAAD 的现有英文文献，以确定潜在的易患因素和预防它的具体策略。
