Hata M, Tabayashi K, Ohmi M, Togo T, Shoji Y, Itoh T, Satoh K
Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Apr;44(4):499-504.
From January of 1987 to July of 1994, 83 patients with acute aortic dissection were treated at our institution. Of these, 7 patients (8%) sustained acute leg ischemia. Angiography showed that one patient had arterial occlusion at the abdominal aorta, three had occlusion at the right common iliac artery, and one had severe right common iliac artery stenosis. Four patients with acute type A dissection underwent emergency replacement of the aortic arch and/or ascending aorta. Three of them were discharged, but one patient died due to renal failure and multiple organ failure. In three patients with acute type B dissection, one with aortic rupture was successfully treated by replacement of the descending thoracic aorta; of the other two who received bypass operations for leg ischemia, one died due to myonephropathic metabolic syndrome and sepsis which were caused by a delay in surgery. In conclusion, emergency thoracic aortic repair should be performed in acute type A dissection with leg ischemia, whereas bypass operation for ischemic leg should be considered in patients of acute type B dissection with leg ischemia when they are not complicated with rupture or visceral ischemia.
1987年1月至1994年7月，我院共治疗83例急性主动脉夹层患者。其中，7例（8%）发生急性下肢缺血。血管造影显示，1例患者腹主动脉闭塞，3例右髂总动脉闭塞，1例右髂总动脉严重狭窄。4例急性A型夹层患者接受了主动脉弓和/或升主动脉的急诊置换术。其中3例出院，但1例患者因肾衰竭和多器官衰竭死亡。3例急性B型夹层患者中，1例主动脉破裂患者通过降胸主动脉置换术成功治疗；另外2例因下肢缺血接受旁路手术的患者中，1例因手术延迟导致的肌肾代谢综合征和败血症死亡。总之，急性A型夹层合并下肢缺血应行急诊胸主动脉修复术，而急性B型夹层合并下肢缺血且无破裂或内脏缺血并发症的患者应考虑行缺血下肢旁路手术。
