Patel Mitul S, Hassoun Heitham T, Davies Mark G, Lumsden Alan B
Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Weill-Cornell Medical College, Houston, TX.
Ann Vasc Surg. 2013 Nov;27(8):1182.e9-12. doi: 10.1016/j.avsg.2012.10.035. Epub 2013 Aug 26.
The decision-making involved in managing type 2 aortic dissections remains challenging despite the advances in endovascular technology. We report a challenging case of a patient presenting with a type 2 aortic dissection and false lumen extension into an infrarenal abdominal aortic aneurysm (AAA). Severe back pain and hypertension were the patient's initial complaints, and dynamic magnetic resonance angiography revealed 1-way pulsatile flow into the AAA sac from the false lumen. This patient underwent endovascular repair with a thoracic and infrarenal aortic endograft, successfully excluding the false lumen and decompressing the infrarenal aneursymal sac. This is a unique presentation of total endovascular repair of a symptomatic type B aortic dissection with a pressurized infrarenal AAA sac from false lumen flow into the sac.
尽管血管内技术取得了进展，但在管理Ⅱ型主动脉夹层时所涉及的决策仍然具有挑战性。我们报告了一例具有挑战性的病例，该患者表现为Ⅱ型主动脉夹层，且假腔延伸至肾下腹主动脉瘤（AAA）。严重背痛和高血压是患者最初的主诉，动态磁共振血管造影显示有单向搏动血流从假腔流入AAA瘤腔。该患者接受了胸段和肾下腹主动脉内支架植入的血管内修复术，成功排除了假腔并减压了肾下动脉瘤腔。这是有症状的B型主动脉夹层伴因假腔血流进入瘤腔而形成的高压肾下AAA瘤腔的全血管内修复的独特表现。
