Department of Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany; Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China.
Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China.
Ann Vasc Surg. 2021 Aug;75:471-478. doi: 10.1016/j.avsg.2021.02.041. Epub 2021 Apr 5.
Aortic intimo-intimal intussusception (AoII) is a rare manifestation of aortic dissection with high mortality. This study aimed to obtain a comprehensive understanding of AoII.
Three databases (PubMed, Scopus, Embase) were searched with predefined search terms ["intimal intussusception", "aortic intussusception", "(circumferential) AND (intimal dissection)" and "(circumferential) AND (aortic dissection)"]. Demographics, clinical manifestations, imaging methods, therapies, and follow-up data were recorded and analyzed.
The literature search finally identified 81 papers comprising 87 patients (Mean age: 53.7 ± 14.9 years old; male: n = 63). According to morphologic criteria (orientation of AoII intimal flap), patients were divided into three groups: antegrade (n = 37), retrograde (n = 49) and bidirectional (n = 1) orientation. The most frequent symptoms in antegrade group were chest pain (62.2%), syncope (27%), and unconsciousness (21.6%), while in retrograde group, they were chest pain (71.4%), dyspnea (20.4%), and back pain (16.3%). Regarding applied imaging modalities, 67.5% of patients in antegrade group were diagnosed with≥2 methods, comparing with 87.7% in retrograde group. A total of 21 patients (24.1%) with AoII finally died, among which 13.8% (12/87) died before surgery.
AoII is a rare form of aortic dissection with high mortality. Antegrade orientation of the intima flap was more accompanied with neurological disorders and asymmetric blood pressure, while retrograde orientation mostly manifested with aortic regurgitation. Application of multiple imaging examinations may detect this rare entity in time.
主动脉内膜-中层内卷入（AoII）是一种罕见的主动脉夹层表现形式，死亡率较高。本研究旨在全面了解 AoII。
通过预设的检索词，在三个数据库（PubMed、Scopus、Embase）中进行检索，检索词为“intimal intussusception”、“aortic intussusception”、“（circumferential）AND（intimal dissection）”和“（circumferential）AND（aortic dissection）”。记录并分析患者的人口统计学、临床表现、影像学方法、治疗方法和随访数据。
文献检索最终确定了 81 篇论文，共 87 例患者（平均年龄：53.7±14.9 岁；男性：n=63）。根据形态学标准（AoII 内膜瓣的方向），患者分为三组：顺行（n=37）、逆行（n=49）和双向（n=1）方向。顺行组最常见的症状是胸痛（62.2%）、晕厥（27%）和意识丧失（21.6%），而逆行组最常见的症状是胸痛（71.4%）、呼吸困难（20.4%）和背痛（16.3%）。在应用的影像学方法方面，顺行组中有 67.5%的患者采用了≥2 种方法诊断，而逆行组中有 87.7%的患者采用了≥2 种方法诊断。共有 21 例（24.1%）AoII 患者最终死亡，其中 13.8%（12/87）在手术前死亡。
AoII 是一种罕见的主动脉夹层形式，死亡率较高。顺行方向的内膜瓣更伴有神经功能障碍和血压不对称，而逆行方向的内膜瓣则主要表现为主动脉瓣反流。应用多种影像学检查方法可能及时发现这种罕见病变。
