自发性孤立性腹主动脉夹层的治疗体会  

Treatment of spontaneous isolated abdominal aortic dissection

作　　者：陈雷 李亚晶 李明轩 王华伟 邓洪儒[1] Chen Lei;Li Yajing;Li Mingxuan;Wang Huawei;Deng Hongru(Department of Vascular surgery,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属复兴医院血管外科,北京100045

出　　处：《血管与腔内血管外科杂志》2022年第5期528-531,共4页Journal of Vascular and Endovascular Surgery

摘　　要：目的分析自发性孤立性腹主动脉夹层(sIAAD)的治疗情况。方法收集2018年1月至2021年7月首都医科大学附属复兴医院收治的12例sIAAD患者的临床资料,分析患者的治疗情况及随访情况。结果4例患者顺利完成动脉瘤腔内修复术(EVAR)治疗,技术成功率100%;8例保守治疗患者中2例出现相关动脉瘤进展,6例发生自发性假腔血栓形成。随访1~34个月,30 d全因病死率为0,随访过程中均未发生再干预或死亡患者。结论对于无症状且无并发症的sIAAD患者进行保守治疗,包括药物治疗和定期随访;而对于存在持续不缓解的症状、腹主动脉瘤(AAA)形成、主动脉破裂、内脏动脉受累、下肢缺血、主动脉内径超过30 mm、伴有穿透性主动脉溃疡或壁内血肿、主动脉扩张每年大于10 mm的患者需行外科手术或介入治疗,EVAR是目前首选的治疗方案。在无症状或非复杂型的sIAAD患者中,控制高血压治疗必不可少,且需密切监测sIAAD扩张。Objective To analyze the treatment of spontaneous isolated abdominal aortic dissection(sIAAD).Method Clinical data of 12 sIAAD patients admitted into Fuxing Hospital Affiliated to Capital Medical University from January 2018 to July 2021 were collected,the treatment and follow-up of patients were analyzed.Result Four patients received endovascular aortic repair(EVAR)successfully with the technical success rate of 100%.Two of 8 patients who received conventional treatment experienced progression of abdominal aortic aneurysm,6 patients experienced spontaneous pseudolumen thrombosis.All patients received 1-34 months of follow up,the all-cause mortality was 0 at 30 days,and there was no re-intervention or death during follow-up.Conclusion Conventional treatment of asymptomatic and uncomplicated sIAAD includes medication and regular follow-up,while patients with persistent unremitting symptoms,abdominal aortic aneurysm formation,aortic dissection,visceral arterial involvement,lower extremity ischemia,and aortic internal diameter greater than 30 mm,with penetrating aortic ulceration or intramural hematoma,and aortic dilatation greater than 10 mm/year require surgical or interventional treatment.EVAR is currently the preferred treatment option.In patients with asymptomatic or uncomplicated sIADD,treatment to control hypertension is essential,and close monitoring is also necessary is essential due to the expansion of sIAAD.

关 键 词：主动脉夹层 高血压 保守治疗 血管成形术 

分 类 号：R543[医药卫生—心血管疾病]