血管内动脉瘤修复术后医源性主动脉夹层开窗术。
Fenestration of an iatrogenic aortic dissection after endovascular aneurysm repair.
机构信息
Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
出版信息
J Endovasc Ther. 2011 Apr;18(2):256-60. doi: 10.1583/10-3330.1.
PURPOSE
To present a case of percutaneous fenestration of a type B aortic dissection after endovascular aneurysm repair (EVAR).
CASE REPORT
An 82-year-old patient with an earlier conventionally inserted aortobi-iliac prosthesis presented with a proximal anastomotic pseudoaneurysm, which was excluded successfully by EVAR. Standard follow-up computed tomographic angiography (CTA) 48 hours after the procedure, however, revealed a type B aortic dissection. Despite conservative antihypertensive therapy, the patient developed abdominal and back pain, and intervention was indicated. Endovascular balloon fenestration of the intimal flap was performed, resulting in relief of pain even though the false lumen remained patent. At 8 months after the procedure, the patient was symptom free, and CTA showed no progression of the persistent type B dissection.
CONCLUSION
Percutaneous fenestration can be used as a therapy of first choice in patients with an acute aortic dissection post EVAR.
目的
介绍 1 例血管内修复（EVAR）后 B 型主动脉夹层的经皮开窗术。
病例报告
一位 82 岁患者曾行传统植入式腹主动脉-髂动脉假体，此次因近端吻合口假性动脉瘤就诊，经 EVAR 成功排除。然而，术后 48 小时的标准 CT 血管造影（CTA）显示 B 型主动脉夹层。尽管进行了保守的降压治疗，患者仍出现腹痛和背痛，需要进行介入治疗。进行了血管内球囊开窗术，切开内膜瓣，缓解了疼痛，尽管假腔仍然开放。术后 8 个月，患者无症状，CTA 显示持续的 B 型夹层无进展。
结论
对于 EVAR 后急性主动脉夹层患者，经皮开窗术可作为首选治疗方法。
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