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髂总动脉瘤血管腔内修复术后发生的A型胸主动脉夹层。

Type A Thoracic Aortic Dissection Following Endovascular Repair of a Common Iliac Artery Aneurysm.

作者信息

Wolfers Matthew P, Yu Qian, Montorfano Lisandro, Bordes Stephen J, King Terry

机构信息

General Surgery, Cleveland Clinic Florida, Weston, USA.

Surgical Anatomy, Tulane University School of Medicine, New Orleans, USA.

出版信息

Cureus. 2021 Mar 18;13(3):e13971. doi: 10.7759/cureus.13971.

DOI:10.7759/cureus.13971
PMID:33884232
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8054837/
Abstract

We discuss a rare case of acute Type A thoracic aortic dissection (TAAD) following endovascular aneurysm repair (EVAR) of a common iliac artery aneurysm, which likely resulted from complications due to aberrant anatomy. Valve replacement, ascending aortic arch graft, and entry tear suture repair were necessary to contain the TAAD. Postoperative computed tomography with angiography (CTA) demonstrated stable disease, and the patient remained asymptomatic. Open and endovascular repair of the descending abdominal aorta was avoided. Few cases in the literature report TAAD following EVAR. Detection and repair of the entry site was crucial for containing the TAAD.

摘要

我们讨论了一例罕见的急性A型胸主动脉夹层（TAAD）病例，该病例发生在髂总动脉瘤腔内修复术（EVAR）之后，可能是由异常解剖结构引起的并发症所致。为控制TAAD，需要进行瓣膜置换、升主动脉弓移植和入口撕裂缝合修复。术后计算机断层扫描血管造影（CTA）显示病情稳定，患者仍无症状。避免了对腹主动脉降部进行开放和腔内修复。文献中很少有关于EVAR术后发生TAAD的病例报道。检测和修复入口部位对于控制TAAD至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25b2/8054837/6443b2cc7957/cureus-0013-00000013971-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25b2/8054837/1d811d7d0fc7/cureus-0013-00000013971-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25b2/8054837/1752abb8b6e7/cureus-0013-00000013971-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25b2/8054837/6443b2cc7957/cureus-0013-00000013971-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25b2/8054837/1d811d7d0fc7/cureus-0013-00000013971-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25b2/8054837/1752abb8b6e7/cureus-0013-00000013971-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25b2/8054837/6443b2cc7957/cureus-0013-00000013971-i03.jpg

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本文引用的文献

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Ann Vasc Surg. 2020 May;65:289.e7-289.e11. doi: 10.1016/j.avsg.2019.11.047. Epub 2019 Dec 19.
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Acute Type B Aortic Dissection One Month After Fenestrated EVAR Procedure.开窗式腔内修复术后1个月的急性B型主动脉夹层
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Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.
Myocardial infarction and haemorrhagic stroke as a rare presentation of acute aortic dissection: a fatal case report.
心肌梗死和出血性中风作为急性主动脉夹层的罕见表现：一例致命病例报告。
Eur Heart J Case Rep. 2023 Oct 24;7(11):ytad529. doi: 10.1093/ehjcr/ytad529. eCollection 2023 Nov.
编辑推荐——欧洲血管外科学会（ESVS）2019年腹主动脉-髂动脉瘤管理临床实践指南
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Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: evaluation and management.胸主动脉和腹主动脉腔内动脉瘤修复术的并发症：评估与处理
Cardiovasc Diagn Ther. 2018 Apr;8(Suppl 1):S138-S156. doi: 10.21037/cdt.2017.09.17.
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Acute Type B Dissection Causing Collapse of EVAR Endograft and Iliac Limb Occlusion.急性B型夹层导致腔内修复术移植物塌陷及髂支闭塞
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