Li Ben, Khoshhal Zeyad, Common Andrew, Qadura Mohammad
Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.
Division of Interventional Radiology, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.
BMJ Case Rep. 2022 Apr 22;15(4):e248149. doi: 10.1136/bcr-2021-248149.
A woman in her 50s presented with uncontrolled hypertension, chest/back pain, paraplegia, right lower limb ischaemia and acute kidney injury. A CT angiogram demonstrated a type B aortic dissection originating distal to the left subclavian artery to bilateral common iliac arteries complicated by occlusion of the right renal artery and right common iliac artery. She was started on intravenous antihypertensive therapy and transferred to our institution for emergent thoracic endovascular aortic repair. Due to bleeding risk from coagulopathy, a spinal drain was not placed immediately post-operatively but instead was inserted after 24 hours while maintaining a mean arterial pressure of 80-100 mm Hg. Postoperatively, her right lower extremity perfusion was re-established, and her renal function recovered following temporary dialysis. At discharge on postoperative day 13, she regained full neurological function.
一名50多岁的女性因高血压控制不佳、胸/背痛、截瘫、右下肢缺血和急性肾损伤前来就诊。CT血管造影显示为B型主动脉夹层，起源于左锁骨下动脉远端至双侧髂总动脉，并伴有右肾动脉和右髂总动脉闭塞。她开始接受静脉降压治疗，并被转至我院进行紧急胸段血管内主动脉修复术。由于凝血功能障碍存在出血风险，术后未立即放置脊髓引流管，而是在术后24小时插入，同时将平均动脉压维持在80-100 mmHg。术后，她的右下肢灌注得以恢复，肾功能在进行临时透析后也恢复了。术后第13天出院时，她的神经功能完全恢复。
