Dinoto Ettore, Pecoraro Felice, Farina Arduino, Viscardi Alessia, Bajardi Guido
Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy.
Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy.
Int J Surg Case Rep. 2020;77S(Suppl):S157-S161. doi: 10.1016/j.ijscr.2020.07.060. Epub 2020 Aug 11.
Data from the literature suggest that in patients with acute type B aortic dissection (ATBAD), associated with AAA, rupture risk is higher at the confluence tract than isolated lessions. Herein, we report a case of ATBAD and AAA managed with simultaneous intervention.
We report a complicated case of a symptomatic patient presenting with a type B aortic dissection and false lumen extension into superior mesenteric artery (SMA) with an infrarenal abdominal aortic aneurysm (AAA). Severe back pain and hypertension were the patient's initial complaints. This patient underwent endovascular repair with a thoracic and infrarenal aortic endograft.
AAA rupture has been detected at admission in three-fourths of patients with ATBAD that extended to or involved a coexisting unoperated atherosclerotic aneurysms. Prompt surgical intervention is essential to deal with this dreadful aortic emergency.
In our experience a totally endovascular solution to treat a complicated ATBAD plus AAA was a rapid solution with low invasivity, no complication and complete healing of patients.
文献数据表明，在伴有腹主动脉瘤（AAA）的急性B型主动脉夹层（ATBAD）患者中，汇合处的破裂风险高于孤立病变处。在此，我们报告一例同时进行干预治疗的ATBAD和AAA病例。
我们报告一例复杂病例，一名有症状的患者表现为B型主动脉夹层，假腔延伸至肠系膜上动脉（SMA），同时伴有肾下腹主动脉瘤（AAA）。患者最初的症状是严重背痛和高血压。该患者接受了胸主动脉和肾下腹主动脉腔内修复术。
在四分之三的ATBAD患者中，若夹层延伸至或累及并存的未手术治疗的动脉粥样硬化性动脉瘤，入院时已检测到AAA破裂。迅速的手术干预对于处理这种可怕的主动脉急症至关重要。
根据我们的经验，采用完全腔内治疗方案治疗复杂的ATBAD合并AAA是一种快速解决办法，具有低侵袭性、无并发症且患者完全康复的优点。
