外科理论与实践››2022,Vol. 27››Issue (04): 304-308.doi:10.16139/j.1007-9610.2022.04.006
常光其(
), 杨文超
收稿日期:2022-06-30出版日期:2022-07-25发布日期:2022-09-20通讯作者:常光其 E-mail:changgq@mail.sysu.edu.cnCHANG Guangqi(), YANG Wenchao
Received:2022-06-30Online:2022-07-25Published:2022-09-20Contact:CHANG Guangqi E-mail:changgq@mail.sysu.edu.cn中图分类号:
常光其, 杨文超. 主动脉夹层合并灌注不良综合征[J]. 外科理论与实践, 2022, 27(04): 304-308.
CHANG Guangqi, YANG Wenchao. Aortic dissection complicated by malperfusion syndrome[J]. Journal of Surgery Concepts & Practice, 2022, 27(04): 304-308.
表1
AD的分支动脉灌注模式
| Ⅰ型:夹层未累及分支动脉,分支动脉完全起于真腔 a. AD假腔未压迫真腔,分支动脉血供良好; b. AD假腔压迫真腔,分支动脉血供受损; c. AD撕脱内膜影响分支动脉开口,血供受损。 Ⅱ型:夹层累及分支动脉 a. 分支动脉内破口较大,AD假腔供血分支动脉且血供良好; b. 分支动脉内无破口或较小破口,AD真腔供血分支动脉; b1. 分支动脉内假腔不压迫真腔,分支动脉血供良好; b2. 分支动脉内假腔压迫真腔,分支动脉血供受损。 Ⅲ型:分支动脉自开口处撕裂 a. 分支动脉血供大多来自假腔,分支动脉伴或不伴夹层,血供良好; b. 分支动脉内夹层假腔压迫真腔,血供受损; c. AD假腔内血栓形成,分支动脉血供受损。 |
图1
AD分支动脉灌注分型图 T:真腔;F:假腔。
| [1] | Czerny M, Schoenhoff F, Etz C, et al. The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA registry[J]. J Am Coll Cardiol, 2015, 65(24):2628-2635. doi:10.1016/j.jacc.2015.04.030URL |
| [2] | Williams DM, Andrews JC, Marx MV, et al. Creation of reentry tears in aortic dissection by means of percutaneous balloon fenestration: gross anatomic and histologic considerations[J]. J Vasc Interv Radiol, 1993, 4(1):75-83. pmid:8425095 |
| [3] | Nagamine H, Ueno Y, Ueda H, et al. A new classification system for branch artery perfusion patterns in acute aortic dissection for examining the effects of central aortic repair[J]. Eur J Cardiothorac Surg, 2013, 44(1):146-153. doi:10.1093/ejcts/ezs631pmid:23242985 |
| [4] | Jonker FH, Patel HJ, Upchurch GR, et al. Acute type B aortic dissection complicated by visceral ischemia[J]. J Thorac Cardiovasc Surg, 2015, 149(4):1081-1086.e1. doi:10.1016/j.jtcvs.2014.11.012URL |
| [5] | Fann JI, Sarris GE, Mitchell RS, et al. Treatment of patients with aortic dissection presenting with peripheral vascular complications[J]. Ann Surg, 1990, 212(6):705-713. pmid:2256762 |
| [6] | Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection[J]. N Engl J Med, 1999, 340(20):1546-1552. doi:10.1056/NEJM199905203402004URL |
| [7] | Khoynezhad A, Donayre CE, Omari BO, et al. Midterm results of endovascular treatment of complicated acute type B aortic dissection[J]. J Thorac Cardiovasc Surg, 2009, 138(3):625-631. doi:10.1016/j.jtcvs.2009.04.044pmid:19698847 |
| [8] | Desai ND, Burtch K, Moser W, et al. Long-term comparison of thoracic endovascular aortic repair(TEVAR) to open surgery for the treatment of thoracic aortic aneurysms[J]. J Thorac Cardiovasc Surg, 2012, 144(3):604-609; discussion 609-611. doi:10.1016/j.jtcvs.2012.05.049URL |
| [9] | Leshnower BG, Szeto WY, Pochettino A, et al. Thoracic endografting reduces morbidity and remodels the thoracic aorta in DeBakey Ⅲ aneurysms[J]. Ann Thorac Surg, 2013, 95(3):914-921. doi:10.1016/j.athoracsur.2012.09.053pmid:23245448 |
| [10] | Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research[J]. Circulation, 2018, 137(17):1846-1860. doi:10.1161/CIRCULATIONAHA.117.031264pmid:29685932 |
| [11] | Grewal S, Contrella BN, Sherk WM, et al. Endovascular management of malperfusion syndromes in aortic dissection[J]. Tech Vasc Interv Radiol, 2021, 24(2):100751. doi:10.1016/j.tvir.2021.100751URL |
| [12] | Müller BT, Reiher L, Pfeiffer T, et al. Surgical treatment of renal artery dissection in 25 patients: indications and results[J]. J Vasc Surg, 2003, 37(4):761-768. doi:10.1067/mva.2003.171URL |
| [13] | Lacombe M. Isolated spontaneous dissection of the renal artery[J]. J Vasc Surg, 2001, 33(2):385-391. pmid:11174794 |
| [14] | Qian SC, Ma WG, Pan XD, et al. Renal malperfusion affects operative mortality rather than late death following acute type A aortic dissection repair[J]. Asian J Surg, 2020, 43(1):213-219. doi:10.1016/j.asjsur.2019.02.004URL |
| [15] | Chen X, Bai M, Sun S, et al. Outcomes and risk management in type B aortic dissection patients with acute kidney injury: a concise review[J]. Ren Fail, 2021, 43(1):585-596. doi:10.1080/0886022X.2021.1905664URL |
| [16] | Blacker DJ, Wijdicks EF, Ramakrishna G. Resolution of severe paraplegia due to aortic dissection after CSF drainage[J]. Neurology, 2003, 61(1):142-143. pmid:12847182 |
| [17] | Osgood MJ, Hicks CW, Abularrage CJ, et al. Duplex ultrasound assessment and outcomes of renal malperfusion syndromes after acute aortic dissection[J]. Ann Vasc Surg, 2019, 57:118-128. doi:10.1016/j.avsg.2018.12.061URL |
| [18] | Nienaber CA, Kische S, Zeller T, et al. Provisional extension to induce complete attachment after stent-graft placement in type B aortic dissection: the PETTICOAT concept[J]. J Endovasc Ther, 2006, 13(6):738-746. doi:10.1583/06-1923.1URL |
| [19] | Bertoglio L, Rinaldi E, Melissano G, et al. The PETTICOAT concept for endovascular treatment of type B aortic dissection[J]. J Cardiovasc Surg (Torino), 2019, 60(1):91-99. |
| [20] | Sobocinski J, Dias NV, Hongku K, et al. Thoracic endovascular aortic repair with stent grafts alone or with a composite device design in patients with acute type B aortic dissection in the setting of malperfusion[J]. J Vasc Surg, 2020, 71(2):400-407.e2. doi:S0741-5214(19)31228-5pmid:31280979 |
| [21] | Iwakoshi S, Dake MD, Irie Y, et al. Management of renal arteries in conjunction with thoracic endovascular aortic repair for complicated stanford type B aortic dissection: the Japanese multicenter study (J-predictive study)[J]. Radiology, 2020, 294(2):455-463. doi:10.1148/radiol.2019190598URL |
| [22] | Barnes DM, Williams DM, Dasika NL, et al. A single-center experience treating renal malperfusion after aortic dissection with central aortic fenestration and renal artery stenting[J]. J Vasc Surg, 2008, 47(5):903-910; discussion 910-911. doi:10.1016/j.jvs.2007.12.057pmid:18455638 |
| [23] | Shu C, Fang K, Luo M, et al. Emergency endovascular stent-grafting for acute type B aortic dissection with symptomatic malperfusion[J]. Int Angiol, 2013, 32(5):483-491. pmid:23903307 |
| [24] | Alsac JM, Girault A, El Batti S, et al. Experience of the zenith dissection Endovascular system in the emergency setting of malperfusion in acute type B dissections[J]. J Vasc Surg, 2014, 59(3):645-650. doi:10.1016/j.jvs.2013.09.004URL |
| [25] | Suzuki T, Mehta RH, Ince H, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection(IRAD)[J]. Circulation, 2003, 108 Suppl 1: Ⅱ 312-Ⅱ 317. |
| [26] | Shimomura T, Takemura H, Narita Y, et al. Surgery for acute aortic dissection concomitant with preceding axi-llofemoral bypass to prevent malperfusion of visceral organs and limb ischemia[J]. Kyobu Geka, 2004, 57(5):385-387. |
| [27] | Henke PK, Williams DM, Upchurch GR Jr, et al. Acute limb ischemia associated with type B aortic dissection: clinical relevance and therapy[J]. Surgery, 2006, 140(4):532-539. doi:10.1016/j.surg.2006.06.019URL |
| [28] | Gargiulo M, Bianchini Massoni C, Gallitto E, et al. Lower limb malperfusion in type B aortic dissection: a systema-tic review[J]. Ann Cardiothorac Surg, 2014, 3(4):351-367. |
| [29] | Sandridge L, Kern JA. Acute descending aortic dissections: management of visceral, spinal cord, and extremity malperfusion[J]. Semin Thorac Cardiovasc Surg, 2005, 17(3):256-261. pmid:16253830 |
| [30] | Elshony H, Idris A, Ahmed A, et al. Spinal cord ischemia secondary to aortic dissection: case report with literature review for different clinical presentations, risk factors, radiological findings, therapeutic modalities, and outcome[J]. Case Rep Neurol, 2021, 13(3):634-655. doi:10.1159/000518197pmid:34720966 |
| [31] | Sandhu HK, Charlton-Ouw KM, Jeffress K, et al. Risk of mortality after resolution of spinal malperfusion in acute dissection[J]. Ann Thorac Surg, 2018, 106(2):473-481. doi:10.1016/j.athoracsur.2018.02.035URL |
| [32] | Takahashi G, Hata M, Tabayashi K. Thoraco-abdominal aortic replacement in chronic phase in a patient with temporary paraplegia after Stanford B acute dissection[J]. Kyobu Geka, 2013, 66(7):551-554. |
| [33] | Ando T, Abe H, Nagata T, et al. Successful staged operation for acute type A aortic dissection with paraplegia[J]. Asian Cardiovasc Thorac Ann, 2013, 21(3):335-337. doi:10.1177/0218492312454016URL |
| [34] | Fujisawa Y, Morishita K, Fukada J, et al. Treatment methods for spinal cord injury caused by acute type B aortic dissection[J]. Asian Cardiovasc Thorac Ann, 2006, 14(6):e106-e107. |
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