Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China.
Department of Breast and Thyroid Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
BMC Surg. 2022 Apr 21;22(1):145. doi: 10.1186/s12893-022-01581-4.
Aortic dissection is one of the most common emergency condition leading to internal organs or lower limb ischemia and aortic rupture. Herein, we described a reverse "cheese wire" endovascular fenestration repair (CWFER) in a patient with complicated abdominal aortic dissection which had never been reported.
A 62-year-old male presented abdominal tear-like pain and acute ischemia of the right lower extremity during the endovascular treatment of celiac trunk aneurysms. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) showed abdominal aortic type B dissection with acute ischemia of the right lower extremity preoperatively. After a detailed preoperative examination, the patient then was performed a reverse CWFER. So far, the patient has been followed-up for 6 months, postoperative CTA demonstrated good stent-graft expansion and perfusion of bilateral common iliac arteries; also, no endoleak was detected.
The right iliac artery in this patient supplied by false lumen, which lead to acute ischemia of the right lower extremity, needed to be treated as an emergency and dealt with promptly. CWFER is a very high-risk treatment that requires the rich experience of vascular surgeon and accurate assessment of aortic dissection. After interventional treatment, the patient recovered uneventfully after 6 months' follow-up.
主动脉夹层是导致内脏器官或下肢缺血和主动脉破裂的最常见急症之一。在此，我们描述了一例复杂的腹主动脉夹层患者采用反向“奶酪丝”血管内开窗修复术（CWFER），这在之前的文献中从未报道过。
一名 62 岁男性在腹主动脉干动脉瘤腔内治疗过程中出现腹部撕裂样疼痛和右下肢急性缺血。计算机断层血管造影（CTA）和数字减影血管造影（DSA）显示术前为腹主动脉 B 型夹层合并右下肢急性缺血。经过详细的术前检查，患者随后进行了反向 CWFER。到目前为止，患者已经随访了 6 个月，术后 CTA 显示支架移植物扩张良好，双侧髂总动脉灌注良好；也未发现内漏。
该患者的右侧髂动脉由假腔供血，导致右下肢急性缺血，需要作为急症进行治疗，并迅速处理。CWFER 是一种风险极高的治疗方法，需要血管外科医生丰富的经验和对主动脉夹层的准确评估。经过介入治疗，患者在 6 个月的随访后恢复良好。
