Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece.
J Vasc Surg. 2013 Dec;58(6):1505-11. doi: 10.1016/j.jvs.2013.05.025. Epub 2013 Jul 3.
Isolated acute abdominal aortic dissection (IAAAD) is considered an unusual clinical entity and is traditionally treated by open surgical repair. We report our single-center experience during the last 9 years, evaluating the outcomes after endovascular repair in this patient population.
All patients with a diagnosis of IAAAD treated in our institute were included in this retrospective review. Between January 2004 and December 2012, 38 patients suffering from an acute aortic dissection were referred regionally for intervention to our department: 24 (63.2%) with a thoracic aortic dissection type B and 14 patients (36.8%, all male; median age, 65 years) with an IAAAD. Demographics, perioperative, procedure-specific, and follow-up data were prospectively aggregated in an electronic database.
Patients suffering from IAAAD presented with acute abdominal pain (n = 13) and acute lumbar pain (n = 1). Insufferable pain and enlargement of the aorta were the main indications for treatment. Mean (± standard deviation) maximal abdominal aortic diameter at presentation was 3.5 ± 0.94 cm (range, 2.6-5.1 cm). None of these patients had a concomitant thoracic aortic dissection. All patients were treated by endovascular means, with a primary technical success rate of 100%. Two patients (14%) died perioperatively from cardiac causes. Median hospital stay was 4.5 days (range, 3-16 days). During a mean follow-up period of 37.41 ± 23.56 months (range, 8-82 months; median, 32.5 months), two patients experienced primary treatment failure needing reintervention that led to a successful outcome. The cumulative free-from-reintervention rate was estimated 90.9% at 58 months (standard error, 8.7%). A full aortic remodeling without any events was noted in all other patients during the follow-up period.
Based on our series, IAAAD may represent a not so rare clinical entity as generally thought, suggesting that it may be underdiagnosed. Endovascular treatment of IAAAD appears to be a feasible and efficient therapeutic approach and might be considered as the first-line treatment in all patients with suitable anatomy.
孤立性急性腹主动脉夹层（IAAAD）被认为是一种不常见的临床病症，传统上采用开放手术修复。我们报告了过去 9 年来我们单中心的经验，评估了该患者人群行血管内修复后的结局。
所有在我院诊断为 IAAAD 的患者均纳入本回顾性研究。2004 年 1 月至 2012 年 12 月，38 例急性主动脉夹层患者因区域性介入治疗被转诊至我院：24 例（63.2%）为胸主动脉夹层 B 型，14 例患者（36.8%，均为男性；中位年龄 65 岁）为 IAAAD。围手术期、手术特异性和随访数据在电子数据库中进行前瞻性汇总。
IAAAD 患者表现为急性腹痛（n=13）和急性腰痛（n=1）。无法忍受的疼痛和主动脉增大是治疗的主要指征。就诊时主动脉最大直径的平均值（±标准差）为 3.5±0.94cm（范围 2.6-5.1cm）。这些患者均无合并胸主动脉夹层。所有患者均采用血管内方法治疗，技术成功率 100%。2 例（14%）患者围手术期因心脏原因死亡。中位住院时间为 4.5 天（范围 3-16 天）。平均随访 37.41±23.56 个月（范围 8-82 个月；中位数 32.5 个月）期间，2 例患者出现原发性治疗失败需要再次介入治疗，最终取得成功。58 个月时估计无再次干预的累积生存率为 90.9%（标准误差 8.7%）。在随访期间，所有其他患者的主动脉完全重塑且无任何事件发生。
根据我们的系列研究，IAAAD 可能不像普遍认为的那样罕见，这表明其可能被漏诊。IAAAD 的血管内治疗似乎是一种可行且有效的治疗方法，对于具有合适解剖结构的所有患者，可能被视为一线治疗。
