Mickley V, Fleiter T
Department of Thoracic and Vascular Surgery, University of Ulm, Germany.
J Vasc Surg. 1998 Aug;28(2):206-14. doi: 10.1016/s0741-5214(98)70156-9.
Nonarteriosclerotic and nonarteritic descending and abdominal aortic coarctation (DAAC) is a rare disease with a great variety of morphologic findings. The additional affliction of renal and other splanchnic arteries often affords complex corrective procedures. We report on our single-center long-term experiences with operative treatment of this malformation.
Over a period of 21 years, 15 patients (10 female and 5 male patients; age range, 8 to 57 years) were operated on for DAAC. Six patients had additional stenoses of eight renal arteries, and three had splanchnic arterial obstructions. At 4 to 25 years after the operation, all surviving patients underwent a clinical and a spiral computed tomography examination.
There was one intraoperative death due to exsanguination after the rupture of a poststenotic aneurysm of the infrarenal aorta. Fourteen patients were discharged free of symptoms. During follow-up, four repeated operations were necessary for renal arterial bypass stenoses or aneurysms. One late death occurred as the result of an unrelated disease.
Complete operative correction of DAAC usually can be accomplished as a single-stage procedure with low morbidity and mortality rates. The reconstruction of all renal arteries is essential to cure hypertension. Consequent follow-up is recommended for detection of late postoperative complications.
非动脉硬化性和非动脉炎性降主动脉及腹主动脉缩窄（DAAC）是一种罕见疾病，具有多种形态学表现。肾动脉和其他内脏动脉的额外病变常常需要复杂的矫正手术。我们报告我们单中心对这种畸形进行手术治疗的长期经验。
在21年的时间里，对15例DAAC患者（10例女性和5例男性患者；年龄范围8至57岁）进行了手术。6例患者的8条肾动脉存在额外狭窄，3例患者存在内脏动脉阻塞。术后4至25年，所有存活患者均接受了临床和螺旋计算机断层扫描检查。
1例患者因肾下主动脉狭窄后动脉瘤破裂出血导致术中死亡。14例患者出院时无症状。随访期间，因肾动脉搭桥狭窄或动脉瘤需要进行4次再次手术。1例患者因无关疾病导致晚期死亡。
DAAC的完全手术矫正通常可作为一期手术完成，发病率和死亡率较低。重建所有肾动脉对于治愈高血压至关重要。建议进行后续随访以发现术后晚期并发症。
