Shikata Daichi, Omura Atsushi, Matsuo Jiro, Matsuda Hitoshi
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
Interact Cardiovasc Thorac Surg. 2020 Jun 1;30(6):940-942. doi: 10.1093/icvts/ivaa020.
A 72-year-old man presenting with lower body malperfusion and complete paralysis was transferred for emergency treatment of a complicated acute type B aortic dissection. Enhanced computed tomography showed occlusion of the true lumen inside the abdominal aorta due to compression of the false lumen, accompanied by a Crawford extension type IV thoraco-abdominal aortic aneurysm. The primary entry tear was located at the level of the tenth thoracic vertebra above the aneurysm. Emergency thoracic endovascular aortic repair was performed to cover the entry tear and to regain perfusion of the lower body. Efforts to perform retrograde insertion of a guidewire from the femoral arteries to pass the occluded abdominal aorta were unsuccessful. A through-and-through guidewire technique between the left brachial artery and the right femoral artery was performed to deliver a Zenith TX-2 stent graft from the right femoral artery. After closure of the primary entry tear, complete recovery from the occlusion of the abdominal aorta was obtained 6 h after the onset. His paralysis recovered completely, and the postoperative course was uneventful without reperfusion injury.
一名72岁男性因下半身灌注不良和完全性瘫痪被转诊，接受复杂急性B型主动脉夹层的紧急治疗。增强计算机断层扫描显示，由于假腔压迫，腹主动脉内真腔闭塞，同时伴有Crawford IV型胸腹主动脉瘤。主要破口位于动脉瘤上方第十胸椎水平。紧急进行胸段血管腔内主动脉修复术，以覆盖破口并恢复下半身灌注。尝试从股动脉逆行插入导丝以穿过闭塞的腹主动脉未成功。采用左肱动脉与右股动脉之间的贯穿导丝技术，从右股动脉输送Zenith TX-2覆膜支架移植物。闭合主要破口后，发病6小时后腹主动脉闭塞完全恢复。他的瘫痪完全恢复，术后过程顺利，无再灌注损伤。
