Guilmet D, Dreyfus G, Bachet J, Goudot B, Bical O, Dubois C, Brodaty D, Teboul B, Tawil N
Arch Mal Coeur Vaiss. 1983 Feb;76(2):167-74.
The authors report a series of 6 cases of recurrent dissection, 4 of which were treated surgically, out of a total of 64 acute dissections of the aorta referred to the CMC Foch, between January 1969 and October 1981. Three types of recurrent dissection were identified: --"de novo" recurrent dissection: a new dissection occurring in part of the aorta previously unaffected with a new intimal tear; --recurrent dissection due to extension of the previous dissection; --"in situ" recurrent dissection. Surgery is the treatment of choice because of the poor prognosis. Extensive resection (sometimes carried out in several stages) and deep hypothermia are valuable techniques when part of the aorta giving off arteries to vital organs has to be replaced. The use of GRF biological glue in the treatment of the original acute dissection has been a significant advance in the prophylaxis of recurrent dissection as it ensures better repair of the distal false lumen (27% persistent false lumens). With respect to an extensive replacement of the dissected vessel, the authors advise operation in several stages, especially in young subjects with Marfan's syndrome who are at high risk of recurrent dissection. All cases of acute dissection of the aorta, operated or not, should be followed up indefinitely with clinical and radiological examination, completed, when necessary, by an angioscan and an aortography.
作者报告了一系列6例复发性主动脉夹层病例，在1969年1月至1981年10月转诊至福煦心血管中心（CMC Foch）的64例急性主动脉夹层病例中，有4例接受了手术治疗。确定了三种类型的复发性主动脉夹层：——“新生”复发性主动脉夹层：在先前未受影响的主动脉部分出现新的夹层，并伴有新的内膜撕裂；——先前夹层延伸导致的复发性主动脉夹层；——“原位”复发性主动脉夹层。由于预后较差，手术是首选治疗方法。当必须替换向重要器官供血的部分主动脉时，广泛切除（有时分阶段进行）和深度低温是有价值的技术。在原发性急性主动脉夹层治疗中使用生长激素释放因子（GRF）生物胶水是预防复发性主动脉夹层的一项重大进展，因为它能确保更好地修复远端假腔（持续性假腔占27%）。对于广泛替换夹层血管，作者建议分阶段进行手术，尤其是对于患有马凡综合征的年轻患者，他们复发性主动脉夹层的风险很高。所有急性主动脉夹层病例，无论是否接受手术，都应通过临床和影像学检查进行无限期随访，必要时辅以血管造影和主动脉造影检查。
