Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Eur J Cardiothorac Surg. 2018 Dec 1;54(6):1142-1144. doi: 10.1093/ejcts/ezy183.
An 81-year-old woman was referred to our centre for emergency surgery with a suspected diagnosis of acute aortic dissection. Laboratory tests showed marked elevation of serum creatinine and blood urea nitrogen. Enhanced computed tomography (CT) demonstrated Type A aortic dissection with a thrombosed false lumen in the ascending aorta. The primary entry tear was located 2 cm distal to the left subclavian artery. Malperfusion of bilateral renal arteries was also evident due to compression by the false lumen. Considering her poor preoperative condition, thoracic endovascular repair of the entry was performed. The primary entry tear was covered using a covered Zenith TX-D stent graft, and a supplemental non-covered Zenith TX-D stent was deployed from the distal edge of the stent graft to the infrarenal aorta. After 5 days of dialysis and additional renal angioplasty for the stenotic left renal artery, her renal function recovered to normal. Her postoperative course was uneventful. Enhanced CT 1 month after surgery showed obliteration of the false lumen of the ascending aorta and patent renal arteries bilaterally.
一位 81 岁女性因疑似急性主动脉夹层被转至我们中心进行急诊手术。实验室检查显示血清肌酐和血尿素氮显著升高。增强计算机断层扫描（CT）显示升主动脉夹层 A 型，升主动脉假腔血栓形成。主要入口撕裂位于左锁骨下动脉远端 2cm 处。由于假腔的压迫，双侧肾动脉也出现灌注不良。考虑到她术前的身体状况不佳，对入口进行了胸主动脉腔内修复术。使用覆盖型 Zenith TX-D 支架移植物覆盖主要入口撕裂，从支架移植物的远端边缘向肾下腹主动脉部署一个补充的非覆盖型 Zenith TX-D 支架。在接受 5 天的透析和左侧肾动脉狭窄的额外血管成形术治疗后，她的肾功能恢复正常。她的术后过程顺利。术后 1 个月的增强 CT 显示升主动脉假腔闭塞，双侧肾动脉通畅。
