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采用杂交二区主动脉弓修复术和胸主动脉腔内修复术治疗逆行扩展的急性B型主动脉夹层早期和晚期灌注不良综合征：一例报告

Management of Early and Late Malperfusion Syndrome in Acute Type B Aortic Dissection with Retrograde Extension Using Hybrid Zone 2 Arch Repair and Thoracic Endovascular Aortic Repair: A Case Report.

作者信息

Votano Daniela, Beaufort Hector W L de, Mortel Rob H W van de, Sonker Uday, Heijmen Robin H, Smeenk Hans G

机构信息

Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.

Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.

出版信息

Aorta (Stamford). 2024 Jun;12(3):74-76. doi: 10.1055/s-0045-1802992. Epub 2025 Feb 25.

DOI:10.1055/s-0045-1802992
PMID:39999985
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11879488/
Abstract

The distal extent of aortic repair in acute aortic dissection and the management of malperfusion in terms of timing and strategy are still debated topics. We present a case of acute type B dissection with retrograde extension to the ascending aorta, with the most proximal intimal tear in the descending thoracic aorta, associated with both early lower extremity and delayed mesenteric malperfusion syndrome, treated effectively by femoral artery open fenestration and hybrid zone 2 arch repair.

摘要

急性主动脉夹层中主动脉修复的远端范围以及关于时机和策略的灌注不良处理仍是存在争议的话题。我们报告一例急性B型夹层，逆行累及升主动脉，降主动脉最近端内膜撕裂，合并早期下肢和延迟性肠系膜灌注不良综合征，通过股动脉开放开窗和2区混合主动脉弓修复得到有效治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ccf9/11879488/523d97448cc9/10-1055-s-0045-1802992-i230015-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ccf9/11879488/56c8925f0f90/10-1055-s-0045-1802992-i230015-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ccf9/11879488/523d97448cc9/10-1055-s-0045-1802992-i230015-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ccf9/11879488/56c8925f0f90/10-1055-s-0045-1802992-i230015-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ccf9/11879488/523d97448cc9/10-1055-s-0045-1802992-i230015-2.jpg

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本文引用的文献

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Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections.血管外科学会（SVS）和胸外科学会（STS）关于 B 型主动脉夹层的报告标准。
J Vasc Surg. 2020 Mar;71(3):723-747. doi: 10.1016/j.jvs.2019.11.013. Epub 2020 Jan 27.
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Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS).涉及主动脉弓的胸主动脉病变治疗的当前选择与建议：欧洲心胸外科学会（EACTS）和欧洲血管外科学会（ESVS）专家共识文件
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Simplifying aortic arch surgery: open zone 2 arch with single branched thoracic endovascular aortic repair completion.简化主动脉弓手术：开放2区主动脉弓并完成单分支胸段血管腔内主动脉修复术。
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4
Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion.早期再灌注策略可改善合并灌注不良的急性 A 型主动脉夹层手术的结局。
J Thorac Cardiovasc Surg. 2018 Aug;156(2):483-489. doi: 10.1016/j.jtcvs.2018.02.007. Epub 2018 Feb 13.
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The Impact of Pre-Operative Malperfusion on Outcome in Acute Type A Aortic Dissection: Results From the GERAADA Registry.急性 A 型主动脉夹层术前灌注不良对预后的影响：GERAADA 登记研究结果。
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Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection.急性 A 型主动脉夹层合并肠系膜动脉灌注不良患者的临床表现、处理和短期转归：国际急性主动脉夹层注册研究的观察结果。
J Thorac Cardiovasc Surg. 2013 Feb;145(2):385-390.e1. doi: 10.1016/j.jtcvs.2012.01.042. Epub 2012 Feb 15.
7
The collateral network concept: a reassessment of the anatomy of spinal cord perfusion.侧支网络概念：对脊髓灌注解剖结构的再评估。
J Thorac Cardiovasc Surg. 2011 Apr;141(4):1020-8. doi: 10.1016/j.jtcvs.2010.06.023.