Clough Rachel E, Nienaber Christoph A
Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK -
Aortic Centre, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK.
J Cardiovasc Surg (Torino). 2017 Apr;58(2):270-277. doi: 10.23736/S0021-9509.16.09849-9. Epub 2017 Jan 3.
Acute aortic dissection is a challenging disease to manage. Type B aortic dissection has traditionally been divided temporally into acute and chronic cases but more recently this classification has been modified to include a sub-acute phase. Computed tomography is the imaging technique used most frequently in diagnosis and management. Active management of blood pressure is essential and should include beta-blockade unless contraindicated. In-hospital outcomes are generally acceptable in patients with medically managed acute uncomplicated type B aortic dissection, with up to 90% of patients surviving to hospital discharge but by 5 years up to 50% of patients are dead with a significant proportion dying from aortic rupture. The aim of endovascular repair is to treat the complications of the dissection, induce aortic remodeling and false lumen thrombosis and it has been shown to result in good long-term outcomes. Stent graft placement however is associated with an incidence of death, stroke, paraplegia and retrograde type A dissection. Some experts now advocate high intensity imaging in the first 14 days to detect development of complications early in the disease course, with planned elective treatment in the subacute phase.
急性主动脉夹层是一种治疗颇具挑战性的疾病。传统上，B型主动脉夹层在时间上被分为急性和慢性病例，但最近这种分类已被修改，纳入了亚急性期。计算机断层扫描是诊断和治疗中最常用的成像技术。积极控制血压至关重要，除非有禁忌证，否则应包括使用β受体阻滞剂。对于接受药物治疗的急性非复杂性B型主动脉夹层患者，院内结局一般尚可，高达90%的患者存活至出院，但到5年时，高达50%的患者死亡，其中很大一部分死于主动脉破裂。血管内修复的目的是治疗夹层的并发症，促使主动脉重塑和假腔血栓形成，并且已显示可带来良好的长期结局。然而，支架植入术与死亡、中风、截瘫和逆行A型夹层的发生率相关。现在一些专家主张在疾病病程的前14天进行高强度成像，以便在疾病早期检测并发症的发生，并在亚急性期进行计划性择期治疗。
