Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Vasc Endovascular Surg. 2024 Nov;58(8):832-840. doi: 10.1177/15385744241276648. Epub 2024 Aug 18.
The aim of this study was to report the clinical presentation and treatment outcomes of patients treated for IAAD with and without abdominal aortic aneurysm (AAA) in a single academic institution in South America.
A retrospective review of all patients with IAAD with or without concomitant AAA between January 2002 and December 2023 from a single academic hospital was performed.
Eighteen patients with IAAD were diagnosed of whom 13 (72.2%) were males. Median age was 63 years (range: 43-88 years). Sixteen (88.8%) patients presented with symptoms, and in two (11.1%) asymptomatic patients IAAD was an incidental finding. Ten (55.5%) patients had concomitant abdominal aortic aneurysm (AAA), with a median size of the aneurysm of 49.5 mm (range: 44-66 mm). No statistical differences in baseline characteristics were seen between patients with concomitant IAAD and AAA and patients with only IAAD. Seven (38.8%) patients presented chronic dissection, and 11 (61.1%) patients had acute dissection. Five (27.7%) patients were treated conservatively with blood pressure, pain control, and antiplatelets; endovascular surgery was performed in eight (44.4%) patients and open surgery in five (27.7%) patients. The complication rate was 22.2% (n = 4), and the mortality rate was 0%. Median follow-up was 36 months (range: 6-240 months). Complete remodeling was seen in all patients except two patients who underwent conservative treatment. Of those, one had partial remodeling, and the other no changed.
Isolated aortic dissection of the abdominal aorta is an uncommon condition, with acceptable different treatment strategies, from conservative to invasive treatments. Sometimes IAAD can concur with AAA, and when so, invasive treatment might be considered. More studies describing the natural history of AAA and its association with IAAD are warranted, as well as further research reporting long-term outcomes on aortic remodeling after different treatment modalities.
本研究旨在报告在南美洲的一家学术机构中，接受治疗的孤立性腹主动脉夹层（IAAD）患者伴或不伴腹主动脉瘤（AAA）的临床表现和治疗结果。
对 2002 年 1 月至 2023 年 12 月期间在一家学术医院接受治疗的所有伴或不伴并发 AAA 的 IAAD 患者进行回顾性研究。
诊断出 18 例 IAAD 患者，其中 13 例（72.2%）为男性。中位年龄为 63 岁（范围：43-88 岁）。16 例（88.8%）患者有症状，2 例（11.1%）无症状患者为偶然发现。10 例（55.5%）患者伴有腹主动脉瘤（AAA），其动脉瘤的中位大小为 49.5mm（范围：44-66mm）。伴或不伴并发 AAA 的 IAAD 患者与仅患有 IAAD 的患者在基线特征方面无统计学差异。7 例（38.8%）患者表现为慢性夹层，11 例（61.1%）患者为急性夹层。5 例（27.7%）患者接受了保守治疗，包括控制血压、疼痛和抗血小板治疗；8 例（44.4%）患者接受了血管内手术，5 例（27.7%）患者接受了开放手术。并发症发生率为 22.2%（n=4），死亡率为 0%。中位随访时间为 36 个月（范围：6-240 个月）。除 2 例接受保守治疗的患者外，所有患者均可见完全重塑。其中 1 例部分重塑，1 例无变化。
孤立性腹主动脉夹层是一种罕见的疾病，有多种治疗策略，从保守治疗到介入治疗均有较好的效果。有时 IAAD 可并发 AAA，此时可考虑介入治疗。需要进一步研究描述 AAA 的自然史及其与 IAAD 的关系，以及报告不同治疗方式后主动脉重塑的长期结果。
