Civilini Efrem, Bertoglio Luca, Mascia Daniele, De Bonis Michele, Chiesa Roberto
Vascular Surgery Department, Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, 20132 Milan, Italy.
Tex Heart Inst J. 2012;39(5):687-91.
Endovascular treatment of complex thoracic pathologic conditions involving the aortic arch can often be appropriate and safe; however, minimally invasive procedures are not always feasible, especially in emergent cases. We report the case of a 78-year-old woman who emergently presented in hemorrhagic shock with a ruptured chronic dissecting aneurysm that involved the aortic arch. Eight years earlier, she had undergone aortic valve replacement and plication of the ascending aorta, which was complicated a day later by Stanford type B dissection, malperfusion, and ischemia that required an axillobifemoral bypass. At the current admission, we successfully treated her surgically through a left thoracotomy, using moderate hypothermic extracorporeal circulation and advanced organ-protection methods. We discuss the surgical indications and our operative strategy in relation to open surgical repair versus endovascular treatment in patients with complex conditions.
对于累及主动脉弓的复杂胸部病理状况，血管内治疗通常是合适且安全的；然而，微创手术并不总是可行的，尤其是在急诊情况下。我们报告了一例78岁女性患者，她因慢性夹层动脉瘤破裂导致出血性休克而急诊入院，该动脉瘤累及主动脉弓。八年前，她接受了主动脉瓣置换和升主动脉折叠术，术后一天出现了B型主动脉夹层、灌注不良和缺血，需要进行腋股动脉旁路移植术。在此次入院时，我们通过左胸切开术，采用中度低温体外循环和先进的器官保护方法，成功地对她进行了手术治疗。我们讨论了复杂病情患者开放手术修复与血管内治疗相比的手术指征和手术策略。
