急性A型主动脉夹层合并急性下肢灌注不良的治疗
Management of acute type A aortic dissection with acute lower extremities malperfusion.
作者信息
Kang Dong Hoon, Kim Jong Woo, Kim Sung Hwan, Moon Seong Ho, Yang Jun Ho, Jung Jae Jun, Park Hyun Oh, Choi Jun Young, Jang In Seok, Lee Chung Eun, Kim Jong Duk, Byun Joung Hun
机构信息
Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Jinju Hospital, Jinju, Republic of Korea.
出版信息
J Cardiothorac Surg. 2019 Nov 27;14(1):206. doi: 10.1186/s13019-019-1033-5.
BACKGROUND
Acute type A aortic dissection complicated by malperfusion is a life - threatening emergency. The optimal management strategy for malperfusion remains controversial.
CASE PRESENTATION
A 46-year-old man presented to another institution with acute type A aortic dissection with abdominal aorta occlusion. Motor and sensory grade of both lower extremities were zero. Immediate antegrade distal perfusion of both lower extremities was achieved, and total arch replacement with left axillo-bifemoral bypass was performed. At the time of discharge, motor and sensory grades of both lower extremities were 2 and 3, respectively.
CONCLUSION
This case demonstrates many of the techniques in the management of acute type A aortic dissection with abdominal aorta occlusion. In this case, direct antegrade perfusion of both lower extremities and axillo-bifemoral bypass may be helpful for patients presenting with severe malperfusion of both lower extremities with acute type A aortic dissection.
背景
急性A型主动脉夹层并发灌注不良是一种危及生命的急症。灌注不良的最佳治疗策略仍存在争议。
病例介绍
一名46岁男性因急性A型主动脉夹层伴腹主动脉闭塞就诊于另一机构。双下肢运动和感觉分级均为零。立即对双下肢进行顺行远端灌注，并进行全弓置换加左腋-双股旁路移植术。出院时，双下肢运动和感觉分级分别为2级和3级。
结论
本病例展示了急性A型主动脉夹层伴腹主动脉闭塞治疗中的许多技术。在本病例中，双下肢直接顺行灌注和腋-双股旁路移植术可能有助于患有急性A型主动脉夹层且双下肢严重灌注不良的患者。
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