Narita Kosuke, Akutsu Koichi, Yamamoto Takeshi, Sato Naoki, Murata Satoru, Mizuno Kyoichi, Tanaka Keiji
Division of Intensive and Cardiac Care Unit, Nippon Medical School Hospital, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2012;18(2):158-61. doi: 10.5761/atcs.cr.11.01712. Epub 2011 Oct 28.
Stanford type B acute aortic dissection is sometimes complicated with compressed true lumen of the descending aorta (Dynamic obstruction) and stenosis of a major aortic branch (Static obstruction), which cause organ malperfusion. In such a case, medical therapy alone is usually not effective and endovascular treatments are required including stent implantation and balloon fenestration. However, it is difficult to determine which strategy should be selected, that is, only stent implantation at dissected branch or simultaneous fenestration with stent implantation. We report a case of a 54-year-old man with lower leg ischemia due to type B aortic dissection, who was successfully treated with stent implantation plus balloon fenestration. This case suggests that balloon fenestration plus stent implantation should be considered when static obstruction in the aortic branches is accompanied by dynamic obstruction in the descending aorta.
B型主动脉夹层有时会并发降主动脉真腔受压（动态梗阻）和主动脉主要分支狭窄（静态梗阻），进而导致器官灌注不良。在这种情况下，单纯药物治疗通常无效，需要进行包括支架植入和球囊开窗术在内的血管内治疗。然而，很难确定应选择哪种策略，即仅在夹层分支处植入支架还是同时进行支架植入和开窗术。我们报告一例54岁因B型主动脉夹层导致小腿缺血的男性患者，经支架植入加球囊开窗术成功治疗。该病例表明，当主动脉分支的静态梗阻伴有降主动脉的动态梗阻时，应考虑球囊开窗术加支架植入。
