Department of Thoracic and Cardiovascular Surgery, School of Medicine, Sapporo Medical University, South-1 West-16, Chuo-ku, Sapporo 080-8543, Japan.
Surg Today. 2013 Sep;43(9):1019-24. doi: 10.1007/s00595-013-0524-6. Epub 2013 Mar 6.
To evaluate the association of previous abdominal aortic aneurysm (AAA) graft replacement with infradiaphragmatic malperfusion in patients with acute aortic dissection.
Between November 2006 and June 2011, 133 patients were referred to our hospital for management of acute aortic dissection. Eight (6.0 %) of these patients had undergone AAA graft replacement prior to the acute aortic dissection. We compared the computed tomography (CT) images of these 8 patients with those of the remaining 125 patients without previous AAA graft replacement, in terms of organ ischemia as a complication induced by acute aortic dissection.
Infradiaphragmatic malperfusion from acute aortic dissection was confirmed in four of the eight patients who had undergone AAA graft replacement. Contrasted CT scan images indicated that the main cause of infradiaphragmatic malperfusion was collapse of the true lumen from compression by the false lumen into the suprarenal aorta. Although there was no significant difference between the groups in terms of cerebral ischemia and myocardial ischemia, bilateral leg ischemia and visceral ischemia occurred more frequently in the patients who had undergone AAA graft replacement.
Previous AAA graft replacement is a risk factor for infradiaphragmatic malperfusion in patients with acute aortic dissection.
评估既往腹主动脉瘤（AAA）移植物置换与急性主动脉夹层患者膈肌下血运不良的关系。
2006 年 11 月至 2011 年 6 月期间，共有 133 名患者因急性主动脉夹层到我院就诊。其中 8 名（6.0%）患者在急性主动脉夹层前曾接受过 AAA 移植物置换。我们比较了这 8 名患者和未行既往 AAA 移植物置换的 125 名患者的 CT 图像，评估其作为急性主动脉夹层并发症的器官缺血情况。
8 名接受 AAA 移植物置换的患者中，有 4 名患者证实存在膈肌下血运不良。对比 CT 扫描图像，膈肌下血运不良的主要原因是假腔向肾上主动脉内压缩导致真腔塌陷。尽管在脑缺血和心肌缺血方面两组之间无显著差异，但接受 AAA 移植物置换的患者双侧下肢和内脏缺血的发生率更高。
既往 AAA 移植物置换是急性主动脉夹层患者膈肌下血运不良的一个危险因素。
