Alattab Nashwan, Althobaiti Shatha A, Alwehaibi Nasser S, Mahjoub Saleh T
Vascular Surgery, King Fahad Medical City, Riyadh, SAU.
General Surgery, Al-Noor Specialist Hospital, Makkah, SAU.
Cureus. 2023 Dec 31;15(12):e51379. doi: 10.7759/cureus.51379. eCollection 2023 Dec.
Acute type A aortic dissection (ATAAD) is a life-threatening emergency that is associated with major morbidity and mortality. Arterial dissections, particularly the brachiocephalic artery, can remain as a residual dissection after type A aortic dissection repair. We present a rare case of brachiocephalic artery dissection due to the clamping effect and the management of ATAAD patients. A 47-year-old male known for aortic aneurysm and uncontrolled hypertension presented with high blood pressure, unequal pulses, and a history of chest pain. A thoracic and abdominal aorta angiogram showed aneurysmal dilatation of the aortic root and ascending aorta with a peripheral linear filling defect shortly distal to the aortic root. The patient underwent the Bentall procedure, hemi-arch replacement, and patent ductus arteriosus closure. The brachiocephalic artery was clamped. The angiogram showed right common carotid occlusion. Endovascular intervention was made by balloon-mounted covered stent graft and kissing technique. The patient had a smooth post-procedure period without major events. Iatrogenic brachiocephalic artery dissection can occur during type A aortic dissection repair and is frequently affected by residual dissection. The decision of intervention versus conservative management is based on a patient's general condition.
急性A型主动脉夹层（ATAAD）是一种危及生命的急症，与严重的发病率和死亡率相关。动脉夹层，尤其是头臂动脉，在A型主动脉夹层修复后可能作为残余夹层存在。我们报告了一例因钳夹效应导致的头臂动脉夹层及ATAAD患者的治疗情况。一名47岁男性，已知患有主动脉瘤且高血压控制不佳，出现高血压、脉搏不等及胸痛病史。胸腹部主动脉血管造影显示主动脉根部和升主动脉瘤样扩张，在主动脉根部远端有一外周线性充盈缺损。患者接受了Bentall手术、半弓置换及动脉导管未闭封堵术。头臂动脉被钳夹。血管造影显示右颈总动脉闭塞。采用球囊扩张覆膜支架移植物和吻合法进行血管内介入治疗。患者术后恢复顺利，未发生重大事件。医源性头臂动脉夹层可发生在A型主动脉夹层修复过程中，且常受残余夹层影响。干预与保守治疗的决策基于患者的一般状况。
