Center For Vascular Care, Washington Hospital Center, 106 Irving St, NW, POB, Suite 3150 N, Washington, DC 20010-2975, USA. sean.o’
J Vasc Surg. 2011 Nov;54(5):1283-9. doi: 10.1016/j.jvs.2011.04.025. Epub 2011 Sep 29.
Acute aortic dissection (AAD) is one of the most common aortic emergencies that vascular specialists are asked to manage. Traditional surgical interventions for cases complicated by malperfusion have resulted in significant morbidity and mortality. With increasing availability of thoracic endografts, endovascular interventions for complicated AAD have become more acceptable. We reviewed our experience with endovascular treatment of AAD since January 2005.
Medical records of patients admitted for AAD from January 1, 2005, to December 31, 2008, were entered into our vascular registry and analyzed for risk factors, extent of dissection, type of management, fate of the false lumen, complications, and survival. There were 249 admissions for aortic dissections during the study period. Our study group included 28 patients with complicated AAD who underwent endovascular intervention.
During the study interval, 28 patients (16 male) underwent 44 procedures. The average age was 54 years. Risk factors differed from the typical atherosclerotic patient and were dominated by an 89.3% incidence of hypertension. Five patients (17.9%) presented with a history of recent cocaine use. The average length of stay was 25.1 days (range, 1-196 days). Stanford type B dissections were present in all but one patient. Twenty-six thoracic endografts were placed in 25 patients. Eight patients required multiple procedures in addition to a thoracic endograft. Morbidity occurred in 17 (60.7%) patients, with renal insufficiency occurring in 11 patients (39.3%) and one requiring permanent dialysis. Four neurologic events occurred: three strokes (10.7%) and one patient (3.6%) with temporary paraplegia. Three patients (10.7%) died in the periprocedural period, with ruptured dissection in one and pericardial tamponade in another. Eight of 10 computed tomography scans (80%) available for review in follow-up showed complete thrombosis of the thoracic false lumen.
Complicated AAD remains a challenging problem, with significant morbidity and mortality rates. However, our early experience with endovascular management offers a favorable reduction in mortality from historic controls.
急性主动脉夹层（AAD）是血管专家需要处理的最常见的主动脉急症之一。传统的外科手术干预对于灌注不良的病例会导致显著的发病率和死亡率。随着胸主动脉内支架的日益普及，对于复杂的 AAD 的血管内干预变得更加可行。我们回顾了自 2005 年 1 月以来我们在 AAD 的血管内治疗方面的经验。
将 2005 年 1 月 1 日至 2008 年 12 月 31 日期间因 AAD 入院的患者的病历输入我们的血管登记处，并对其危险因素、夹层范围、治疗类型、假腔的命运、并发症和存活率进行分析。在研究期间，共有 249 例主动脉夹层患者入院。我们的研究组包括 28 例接受血管内干预的复杂 AAD 患者。
在研究期间，28 名男性患者（89.3%患有高血压）接受了 44 次治疗。患者的平均年龄为 54 岁。危险因素与典型的动脉粥样硬化患者不同，主要为高血压。5 名患者（17.9%）有近期可卡因使用史。平均住院时间为 25.1 天（范围 1-196 天）。除了 1 名患者外，所有患者均为 Stanford 型 B 型夹层。25 名患者中放置了 26 个胸主动脉内支架。8 名患者除了胸主动脉内支架还需要进行多次治疗。17 名患者（60.7%）发生了并发症，其中 11 名患者（39.3%）出现肾功能不全，1 名患者需要永久性透析。4 名患者发生了神经系统事件：3 名中风（10.7%）和 1 名暂时截瘫患者（3.6%）。3 名患者（10.7%）在围手术期死亡，其中 1 名死于夹层破裂，另 1 名死于心包填塞。在可进行随访的 10 次计算机断层扫描中，有 8 次（80%）显示胸主动脉假腔完全血栓形成。
复杂的 AAD 仍然是一个具有挑战性的问题，发病率和死亡率都很高。然而，我们在血管内治疗方面的早期经验提供了从历史对照中降低死亡率的有利结果。
