Bastos Gonçalves F, Metz R, Hendriks J M, Rouwet E V, Muhs B E, Poldermans D, Verhagen H J M
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
J Cardiovasc Surg (Torino). 2010 Oct;51(5):657-67.
Aortic dissection is a devastating cardiovascular condition with an incidence of 3,5:100 000. It is classified according to anatomic extent, mechanism of lesion, duration from index event and course (uncomplicated vs. complicated). Intramural hematoma and penetrating aortic ulcers share many of the features of classic dissections, but tend to occur in older patients with advanced atherosclerosis. In uncomplicated type-B dissection, conservative treatment with tight blood pressure and heart rate control is safe and effective. Early stent-graft implantation may, however, result in more favorable aortic remodeling and reduced late complications. For acute complicated cases intervention is usually required. Stent-graft coverage of the entry tear frequently resolves malperfusion, but the role of the false lumen in organ perfusion must be assessed and endovascular revascularization performed if necessary. In chronic type-B dissections, coverage of the entry tear likely results in continued pressurization of the false lumen due to rigidity of the dissecting membrane and distal fenestrations. Better understanding of the different disease mechanisms involved, imaging advances and introduction of dedicated stent-grafts are expected to further improve patient outcomes in the future. Primary and secondary pharmacological prevention, stricter follow-up protocols and screening of family members may also prove valuable. Better patient selection will allow preventive treatment with low morbidity for those at higher risk of complications.
主动脉夹层是一种严重的心血管疾病，发病率为3.5:100000。它根据解剖范围、病变机制、距索引事件的持续时间和病程（简单型与复杂型）进行分类。壁内血肿和穿透性主动脉溃疡具有许多典型夹层的特征，但往往发生在患有晚期动脉粥样硬化的老年患者中。在简单型B型夹层中，通过严格控制血压和心率进行保守治疗是安全有效的。然而，早期植入支架型人工血管可能会导致更有利的主动脉重塑并减少晚期并发症。对于急性复杂病例，通常需要进行干预。支架型人工血管覆盖入口撕裂通常可解决灌注不良问题，但必须评估假腔在器官灌注中的作用，必要时进行血管腔内血运重建。在慢性B型夹层中，由于夹层膜的僵硬和远端开窗，覆盖入口撕裂可能会导致假腔持续受压。对所涉及的不同疾病机制的更好理解、影像学进展以及专用支架型人工血管的引入有望在未来进一步改善患者的预后。一级和二级药物预防、更严格的随访方案以及对家庭成员的筛查也可能被证明是有价值的。更好的患者选择将使对那些并发症风险较高的患者进行低发病率的预防性治疗成为可能。
