Zhao Yikun, Li Heng, Guo Yuanyuan
Vascular Surgery Department, Fuwai Yunnan Cardiovascular Hospital, Kunming, China.
SAGE Open Med Case Rep. 2025 Feb 10;13:2050313X251316985. doi: 10.1177/2050313X251316985. eCollection 2025.
Type B aortic dissection represents a life-threatening cardiovascular event, necessitating a comprehensive treatment approach that includes anti-impulse therapy for blood pressure and heart rate control, movement restriction, analgesia, sedation, and consideration of subsequent endovascular or open surgery. Management of acute aortic dissection involves stringent blood pressure control to prevent extension of the dissection, which is critical in both surgical preparation and conservative treatment strategies. While the treatment regimen is relatively well-established, and early and long-term follow-up results are promising, there have been reports of adverse events during treatment. In this context, we present a case of a 40-year-old male with acute type B aortic dissection who developed cerebral hypoperfusion as a consequence of rapid blood pressure reduction, underscoring the need for balanced hemodynamic management. Following thoracic endovascular aortic repair surgery and hyperbaric oxygen therapy, the patient fully recovered 6 months later with no lingering sequelae. While current guidelines emphasize specific numerical values for blood pressure control in type B aortic dissection, the case underscores the potential need for a more individualized approach tailored to the unique characteristics of each patient.
B型主动脉夹层是一种危及生命的心血管事件，需要综合治疗方法，包括进行抗冲击治疗以控制血压和心率、限制活动、镇痛、镇静，并考虑后续的血管内或开放手术。急性主动脉夹层的管理涉及严格控制血压以防止夹层扩展，这在手术准备和保守治疗策略中都至关重要。虽然治疗方案相对成熟，早期和长期随访结果也很有前景，但仍有治疗期间不良事件的报道。在此背景下，我们报告一例40岁男性急性B型主动脉夹层患者，该患者因血压迅速下降而出现脑灌注不足，强调了平衡血流动力学管理的必要性。经过胸主动脉腔内修复手术和高压氧治疗，患者6个月后完全康复，没有留下后遗症。虽然当前指南强调B型主动脉夹层血压控制的具体数值，但该病例强调了可能需要根据每个患者的独特特征采取更个体化的方法。
