The George Washington University Hospital, Washington, DC.
Heart Surg Forum. 2020 Sep 25;23(5):E699-E702. doi: 10.1532/hsf.3209.
The management of patients with chronic Stanford type B aortic dissection who develop complications requires intervention without clear guidelines. Chronic aortic dissection is difficult to treat and often leads to significant morbidity and mortality. We report a complex case of chronic Stanford type B aortic dissection (TBAD) with an expanding false lumen aneurysm and distal fenestrations that required a multi-stage hybrid repair.
The patient first underwent a median sternotomy for the ascending aorta to the innominate artery and innominate artery to the left carotid artery bypass, followed by a left carotid to left axillary artery bypass. Due to continued aneurysmal growth, the patient ultimately underwent total cervical and abdominal aortic debranching as well as thoracic and abdominal endovascular grafting with iliac excluders. The patient recovered well after the surgery and had no further expansion of the aneurysm at 12-month follow up.
Endovascular repairs have been the mainstay of chronic TBAD repair, but hybrid approaches may be necessary for difficult repairs. A multi-stage hybrid repair approach has been successful in a patient who had a chronic type B aortic dissection with aneurysmal degeneration that failed medical management.
患有慢性斯坦福 B 型主动脉夹层并出现并发症的患者的管理需要进行干预，但目前没有明确的指导方针。慢性主动脉夹层难以治疗，常导致严重的发病率和死亡率。我们报告了一例复杂的慢性斯坦福 B 型主动脉夹层（TBAD）病例，其假腔动脉瘤扩张，并伴有远端开窗，需要进行多阶段杂交修复。
患者首先接受正中胸骨切开术，从升主动脉至无名动脉，再从无名动脉至左颈总动脉旁路，然后再进行左颈总动脉至左腋动脉旁路。由于持续的瘤体生长，患者最终接受了全颈动脉和腹主动脉去分支术，以及胸、腹主动脉血管内支架置入术，并使用髂外隔绝器。患者术后恢复良好，在 12 个月的随访中，动脉瘤无进一步扩张。
血管内修复一直是慢性 TBAD 修复的主要方法，但对于复杂的修复，杂交方法可能是必要的。多阶段杂交修复方法已成功应用于一例慢性 B 型主动脉夹层患者，该患者因药物治疗无效而出现动脉瘤退行性变。
