Rodriguez Czaplicki Elias Jose, Martinez Mira Cristina, Anaya Sifuentes Dina Magaly, Aisa Aldama Jorge
Vascular Surgery Unit, General and University Hospital, Elche, Spain.
EJVES Short Rep. 2019 Aug 20;44:38-43. doi: 10.1016/j.ejvssr.2019.07.004. eCollection 2019.
Acute aortic dissection after endovascular repair of an aortic aneurysm is a rare but serious condition, with potential complications that can result in the death of the patient.
This is the case of a patient diagnosed with a type IV thoraco-abdominal aneurysm with involvement of both iliac arteries who underwent endovascular repair with a four fenestration device and a left iliac branch. One month after the procedure, the patient presented with a type B acute aortic dissection that extended from the left subclavian artery to the proximal stent of the fenestrated graft. This dissection was treated by thoracic endovascular aortic repair, and after a problematic post-operative period, the patient was discharged after 30 days.
Occurrence of an acute aortic dissection after endovascular repair of an aortic aneurysm has rarely been reported in the literature. Development of these dissections has been related to factors such as excessive oversizing, use of devices with active fixation systems, or injuries during the procedure, although it is believed that the late onset would indicate that it was a de novo dissection. The presence of an aortic dissection can lead to the collapse and occlusion of the previous endograft and even to aortic rupture, and mortality in reported cases reaches 30%. The authors suggest that endovascular treatment should be considered in these patients.
腹主动脉瘤血管腔内修复术后发生急性主动脉夹层是一种罕见但严重的情况，可能引发并发症，导致患者死亡。
本文报道一例IV型胸腹主动脉瘤患者，双侧髂动脉均受累，采用四开窗装置和左髂支进行血管腔内修复。术后1个月，患者出现B型急性主动脉夹层，从左锁骨下动脉延伸至开窗移植物的近端支架。通过胸主动脉腔内修复术治疗该夹层，经过一段术后问题期后，患者在30天后出院。
腹主动脉瘤血管腔内修复术后发生急性主动脉夹层的情况在文献中鲜有报道。这些夹层的发生与多种因素有关，如过度超大尺寸、使用带有主动固定系统的装置或手术过程中的损伤，尽管有人认为延迟发病表明这是一种新发夹层。主动脉夹层的存在可导致先前植入的血管内移植物塌陷和闭塞，甚至导致主动脉破裂，报道病例的死亡率达30%。作者建议应对这些患者考虑采用血管腔内治疗。
