Vermeersch N, Hendriks J M, Lauwers P, Salgado R, Van Schil P E
Department of thoracic and vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium.
Acta Chir Belg. 2015 Jul-Aug;115(4):293-8. doi: 10.1080/00015458.2015.11681115.
Aortic dissection limited to the abdominal aorta is a rare clinical entity with non-specific clinical features. Optimal treatment, as well as natural history and progression of the disease, remain unclear. In 1992 we -reported 5 cases of isolated abdominal aortic dissection (IAAD) and in the present paper we update our series with 5 additional patients. A concise literature review is also provided.
Between 1992 and 2014, we diagnosed 5 patients with IAAD (4 men, mean age 60.6 years, range 45-77). No patient presented with acute onset of symptoms. One patient was diagnosed with a periumbilical bruit, and diagnosis was made with magnetic resonance (MR)-angiography. Other diagnoses were incidental findings on computed tomographic (CT) scanning. Dissection was located infrarenally in four cases and at the celiac trunk in one case.
All cases were treated conservatively with hypertension control and close follow-up. Follow-up period ranged from 10 months to 20 years and was performed yearly by CT- or MR-angiography and blood pressure monitoring. All patients remained symptom-free, all dissection lengths remained stable. Slowly increasing post-dissection aneurysmal dilatation was encountered in two patients. We combined results of these five new patients with five previously diagnosed and reported patients at our center. Treatment was surgical in only one out of 10 patients. There was no disease-related mortality during follow-up.
Based on our case series, IAAD remains a rare clinical condition with relative benign clinical course. Treatment was almost exclusively conservative. Recent publications state IAAD might be underrecognized and under-diagnosed compared to thoracic aortic dissections.
局限于腹主动脉的主动脉夹层是一种临床罕见病，临床特征不具特异性。该病的最佳治疗方法以及自然病史和病情进展仍不明确。1992年我们报告了5例孤立性腹主动脉夹层（IAAD），本文将新增的5例患者纳入我们的病例系列并进行更新。同时还提供简要的文献综述。
1992年至2014年期间，我们诊断出5例IAAD患者（4名男性，平均年龄60.6岁，范围45 - 77岁）。所有患者均无急性起病症状。1例患者因脐周血管杂音被诊断出，通过磁共振（MR）血管造影确诊。其他诊断是在计算机断层扫描（CT）时偶然发现的。4例夹层位于肾下，1例位于腹腔干。
所有病例均采用控制高血压和密切随访的保守治疗。随访期为10个月至20年，每年通过CT或MR血管造影及血压监测进行随访。所有患者均无症状，所有夹层长度保持稳定。2例患者出现夹层后动脉瘤缓慢扩张。我们将这5例新患者的结果与本中心之前诊断并报告的5例患者的结果合并。10例患者中仅1例行手术治疗。随访期间无疾病相关死亡。
基于我们的病例系列，IAAD仍然是一种罕见的临床疾病，临床病程相对良性。治疗几乎均为保守治疗。近期出版物指出，与胸主动脉夹层相比，IAAD可能未得到充分认识和诊断。
