Nikolaos Schizas, Vasilios Patris, Niki Lama, Argyriou Eleftherios Orestis, Theodoros Kratimenos, Mihalis Argiriou
Evangelismos General Hospital of Athens, Department of Cardio Thoracic and Vascular Surgery, Athens, Greece.
Kapodistrian University of Athens, Research Unit of Radiology and Medical Imaging, Greece.
J Vasc Bras. 2020 Nov 23;19:e20200045. doi: 10.1590/1677-5449.200045.
The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).
复杂急性B型主动脉夹层病例中存在灌注不良综合征是一个负面预测因素，提示需要紧急干预。诸如布勒尔弓等解剖变异会形成吻合通道并可维持内脏血供。在本病例报告中，我们描述了一名54岁B型主动脉夹层男性患者的整体治疗情况。起初，按照单纯B型夹层的治疗建议选择了保守治疗，但夹层病情恶化。尽管在计算机断层扫描（CT）血管造影中检测到腹腔动脉严重闭塞，但存在布勒尔弓解剖变异，可提供充足的内脏血供。考虑到这一发现后，患者接受胸主动脉腔内修复术（TEVAR）治疗，效果良好。
