Faries Christopher M, Tadros Rami O, Lajos Paul S, Vouyouka Ageliki G, Faries Peter L, Marin Michael L
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
J Vasc Surg. 2016 Nov;64(5):1246-1250. doi: 10.1016/j.jvs.2016.04.030. Epub 2016 Jul 18.
The purpose of this study was to report the presentation, treatment, and follow-up of isolated infrarenal aortic dissections.
A review of 37 patients with isolated infrarenal aortic dissections was performed. Computed tomography scans with intravenous administration of contrast material were examined for all patients; catheter-based angiography, magnetic resonance angiography, and duplex ultrasound were used selectively. In dissections associated with the development of abdominal aortic aneurysm (AAA), the aneurysm growth rate was determined by measuring the change in maximum aneurysm diameter over time and dividing that by the duration of observation.
The majority of infrarenal abdominal aortic dissection patients were male (67.6%). Hypertension (77.1%) and hyperlipidemia (77.1%) were the most common comorbidities among these patients. Aortic atherosclerosis was present in the majority of patients (60.0%); 67.6% of dissections were discovered incidentally and were asymptomatic. The mean dissection length was 5.84 ± 4.23 cm. Concomitant AAAs were present in 48.6% of cases with an average maximum diameter of 4.38 ± 1.41 cm. The aneurysm growth rate was 1.2 mm/y. Aneurysms were significantly larger in men than in women (4.87 ± 1.31 vs 3.12 ± 0.67 cm; P = .001). Endovascular intervention was performed on 14 (37.8%) patients, open surgery was performed on 1 (2.7%) patient, and surveillance with conservative medical treatment was used for 22 (59.5%) patients. Ten patients were treated successfully with endovascular repair for progressive aneurysm expansion. At the time of intervention, the mean AAA diameter was 5.04 ± 1.39 cm. The mean growth rate for aneurysms that were intervened on was 2.3 mm/y. The mean diameter of AAAs that were not intervened on was 3.56 ± 1.04 cm. Type II endoleaks were observed in three (30%) patients who underwent endovascular repair. None of these were associated with aneurysm growth and none required reintervention. The mortality rate for endovascular intervention was 0%. The only open surgical repair performed was on a patient with a ruptured AAA, which the patient did not survive. Angioplasty with stent or stent graft placement was performed in four patients for the treatment of symptomatic arterial insufficiency resulting from aortic dissection. No patients experienced restenosis, and no reinterventions were performed.
Isolated infrarenal aortic dissection is an uncommon vascular disease that is related to hypertension, hyperlipidemia, and atherosclerosis and may be associated with infrarenal AAA formation. The presence of dissection does not appear to increase the risk of complication or mortality for repair of concomitant aneurysm or for treatment of stenosis.
本研究旨在报告孤立性肾下腹主动脉夹层的临床表现、治疗及随访情况。
对37例孤立性肾下腹主动脉夹层患者进行回顾性研究。所有患者均接受了静脉注射造影剂的计算机断层扫描；选择性地使用了基于导管的血管造影、磁共振血管造影和双功超声检查。在与腹主动脉瘤（AAA）形成相关的夹层中，通过测量动脉瘤最大直径随时间的变化并除以观察期来确定动脉瘤生长速率。
大多数肾下腹主动脉夹层患者为男性（67.6%）。高血压（77.1%）和高脂血症（77.1%）是这些患者中最常见的合并症。大多数患者（60.0%）存在主动脉粥样硬化；67.6%的夹层是偶然发现且无症状的。夹层的平均长度为5.84±4.23厘米。48.6%的病例伴有AAA，平均最大直径为4.38±1.41厘米。动脉瘤生长速率为1.2毫米/年。男性的动脉瘤明显大于女性（4.87±1.31对3.12±0.67厘米；P = 0.001）。14例（37.8%）患者接受了血管内介入治疗，1例（2.7%）患者接受了开放手术，22例（59.5%）患者采用保守药物治疗并进行随访。10例患者因动脉瘤进行性扩张而成功接受了血管内修复治疗。在干预时，AAA的平均直径为5.04±1.39厘米。接受干预的动脉瘤的平均生长速率为2.3毫米/年。未接受干预的AAA的平均直径为3.56±1.04厘米。在接受血管内修复的3例（30%）患者中观察到Ⅱ型内漏。这些内漏均与动脉瘤生长无关，均无需再次干预。血管内介入治疗的死亡率为0%。唯一的开放手术修复是针对一名AAA破裂的患者，该患者未能存活。4例患者接受了血管成形术并置入支架或支架移植物，以治疗主动脉夹层导致的有症状动脉供血不足。没有患者发生再狭窄，也未进行再次干预。
孤立性肾下腹主动脉夹层是一种罕见的血管疾病，与高血压、高脂血症和动脉粥样硬化有关，可能与肾下AAA的形成有关。夹层的存在似乎并未增加修复合并动脉瘤或治疗狭窄的并发症风险或死亡率。
