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血管内超声引导下腹腔干动脉支架置入术治疗急性A型主动脉夹层后肝脏低灌注：1例报告

Intravascular Ultrasound-Guided Stenting of the Celiac Artery for Hepatic Hypoperfusion After Acute Type A Aortic Dissection: A Case Report.

作者信息

Shoemaker Hailey B, Malkoc Aldin, Barmanwalla Amira, Gnanadev Raja, Daoud Amanda, Lee Michelle, Tayyarah Majid

机构信息

Surgery, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, USA.

General Surgery, Arrowhead Regional Medical Center, Colton, USA.

出版信息

Cureus. 2024 May 18;16(5):e60566. doi: 10.7759/cureus.60566. eCollection 2024 May.

DOI:10.7759/cureus.60566
PMID:38894802
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11182733/
Abstract

Type A aortic dissection is a life-threatening emergency requiring prompt surgical treatment. The dissection itself and use of cardiopulmonary bypass can lead to further postoperative complications, including aortic branch occlusion, thrombosis, ischemia, and fatal end-organ damage. Celiac artery occlusion with consequent hepatic malperfusion is one feared complication of aortic dissection, which requires urgent surgical intervention. Optimal management of celiac artery dissection in the setting of type A aortic dissection has not yet been described in the literature. In this report, we describe a 39-year-old female patient with hypertension who was found to have celiac artery dissection and impending hepatic failure less than 48 hours after emergent ascending aortic replacement for type A aortic dissection. Placement of an ultrasound-guided endovascular celiac artery stent enabled reperfusion of the liver, ultimately saving the patient's life.

摘要

A型主动脉夹层是一种危及生命的急症，需要迅速进行手术治疗。夹层本身以及体外循环的使用可导致进一步的术后并发症，包括主动脉分支闭塞、血栓形成、缺血和致命的终末器官损害。腹腔干动脉闭塞并随之出现肝脏灌注不良是主动脉夹层令人担忧的并发症之一，需要紧急手术干预。目前文献中尚未描述在A型主动脉夹层情况下腹腔干动脉夹层的最佳治疗方法。在本报告中，我们描述了一名39岁的高血压女性患者，在因A型主动脉夹层行急诊升主动脉置换术后不到48小时，被发现存在腹腔干动脉夹层且即将发生肝衰竭。放置超声引导下的血管内腹腔干动脉支架实现了肝脏再灌注，最终挽救了患者的生命。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/05c2fd483899/cureus-0016-00000060566-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/0c625e6fc1b4/cureus-0016-00000060566-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/405d2621a8f9/cureus-0016-00000060566-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/de4490fed47d/cureus-0016-00000060566-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/74ddb3f4808d/cureus-0016-00000060566-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/05c2fd483899/cureus-0016-00000060566-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/0c625e6fc1b4/cureus-0016-00000060566-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/405d2621a8f9/cureus-0016-00000060566-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/de4490fed47d/cureus-0016-00000060566-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/74ddb3f4808d/cureus-0016-00000060566-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/210b/11182733/05c2fd483899/cureus-0016-00000060566-i05.jpg

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本文引用的文献

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General features, management strategies, and outcomes of symptomatic spontaneous isolated celiac artery dissection.症状性自发性孤立性腹腔干夹层的一般特征、管理策略及预后
Front Surg. 2022 Oct 21;9:972276. doi: 10.3389/fsurg.2022.972276. eCollection 2022.
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Arc of Buhler: A lifesaving anatomic variation. A case report.布勒尔弓：一种救命的解剖变异。病例报告。
J Vasc Bras. 2020 Nov 23;19:e20200045. doi: 10.1590/1677-5449.200045.
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Acalculous Ischemic Cholecystitis Caused by Spontaneous Celiac Artery Dissection.自发性腹腔干夹层导致的无结石性缺血性胆囊炎。
Intern Med. 2022 Jan 1;61(1):53-58. doi: 10.2169/internalmedicine.7793-21. Epub 2021 Jun 26.
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Type A aortic dissection involving the superior mesenteric artery with peripheral malperfusion managed with a hybrid approach: a case report.
Hong Kong Med J. 2019 Oct;25(5):403-405. doi: 10.12809/hkmj177127.
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Retrograde stenting of the superior mesenteric artery is the procedure of choice for dissection of the aorta with mesenteric compromise.肠系膜上动脉逆行支架置入术是治疗伴有肠系膜受累的主动脉夹层的首选方法。
J Vasc Surg Cases Innov Tech. 2019 Oct 5;5(4):431-434. doi: 10.1016/j.jvscit.2019.06.014. eCollection 2019 Dec.
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Outcomes and risk factors of postoperative hepatic dysfunction in patients undergoing acute type A aortic dissection surgery.急性A型主动脉夹层手术患者术后肝功能障碍的结局及危险因素
J Thorac Dis. 2019 Aug;11(8):3225-3233. doi: 10.21037/jtd.2019.08.72.
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Factors associated with acute stroke after type A aortic dissection repair: An analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database.与 A 型主动脉夹层修复术后急性脑卒中相关的因素：胸外科医生学会国家成人心脏手术数据库分析。
J Thorac Cardiovasc Surg. 2020 Jun;159(6):2143-2154.e3. doi: 10.1016/j.jtcvs.2019.06.016. Epub 2019 Jun 18.
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[A case of emergency surgery for acalculous gangrenous cholecystitis due to celiac artery dissection].[一例因腹腔干动脉夹层导致的非结石性坏疽性胆囊炎急诊手术病例]
Nihon Shokakibyo Gakkai Zasshi. 2019;116(5):428-433. doi: 10.11405/nisshoshi.116.428.
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