2042 Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
Division of Vascular Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
Innovations (Phila). 2021 Mar-Apr;16(2):192-194. doi: 10.1177/1556984520983790. Epub 2021 Jan 22.
Surgical treatment of acute DeBakey type I aortic dissection does not address the entire aorta, which can leave anatomically complex residual aortic dissection in the aortic arch and descending aorta. Open repair has been the standard treatment for this pathology. When the lesions are located in the aortic arch, re-do total arch replacement needs to be performed. Plug placement to close small entry tears in the aortic arch has been reported. This article reports about a 79-year-old man who underwent hemiarch replacement for acute DeBakey type I aortic dissection. One year later, his proximal descending aorta dilated to 6.3 cm. The patient was treated with Amplatzer plug in the false lumen, and a stent graft was placed in the true lumen. Follow-up computed tomography scan confirmed complete thrombosis of the false lumen in the descending aorta which had decreased from 6.3 to 4.0 cm. Plug placement in the false lumen in the aortic arch is a potential treatment strategy for anatomically complex residual aortic dissection to induce thrombosis of the false lumen and encourage remodeling.
外科治疗急性 DeBakey Ⅰ型主动脉夹层并不能覆盖整个主动脉，这可能会在主动脉弓和降主动脉中留下解剖结构复杂的残余主动脉夹层。开放修复一直是这种病理的标准治疗方法。当病变位于主动脉弓时，需要重新进行全主动脉弓置换。已经有报道称，可采用封堵装置来封闭主动脉弓中的小入口撕裂。本文报道了一位 79 岁男性，他因急性 DeBakey Ⅰ型主动脉夹层而行半弓置换术。一年后，其降主动脉近端扩张至 6.3cm。患者接受了 Amplatzer 封堵器在假腔中的治疗，并在真腔中放置了支架移植物。随访 CT 扫描证实降主动脉假腔完全血栓形成，从 6.3cm 缩小至 4.0cm。在主动脉弓的假腔中放置封堵器是一种治疗解剖结构复杂的残余主动脉夹层的潜在策略，可诱导假腔血栓形成并促进重塑。
