Early TEVAR combined with EVT achieved rapid organ reperfusion and avoided bowel resection in a patient with acute type non-A non-B aortic dissection complicated by malperfusion syndrome.
Case Report (n=1)
No
Does early TEVAR combined with EVT improve outcomes and achieve rapid organ reperfusion in a patient with acute type non-A non-B aortic dissection complicated by malperfusion syndrome?
Early TEVAR combined with EVT for rapid organ reperfusion is a viable strategy to avoid bowel resection in acute type non-A non-B aortic dissection complicated by malperfusion syndrome.
症例は54歳男性．突然の背部痛と両下肢の脱力および冷感にて救急要請し，当院へ搬送された．造影CT検査にて弓部大動脈にEntryを認め，弓部大動脈から両側外腸骨動脈に至るnon-A non-B型急性大動脈解離を認め，高度真腔狭小による腸管虚血と両下肢虚血を合併していた．早期の虚血解除のため，真腔拡大目的にEntryを残したまま遠位弓部大動脈から胸部大動脈ステントグラフト内挿術（TEVAR）を施行し，さらに上腸間膜動脈の偽腔血栓化による真腔狭小に対して血管内治療（EVT）を施行した．急性期の経過はおおむね良好で，腸管切除術を回避し得た．発症4カ月で偽腔拡大に対して，待機的に上行完全弓部大動脈人工血管置換術およびオープンステントグラフト内挿術を施行し，術後経過は良好であった．臓器灌流障害を伴う急性大動脈解離に対して，TEVARとEVTの先行にて早期の臓器再灌流を試みて良好な転帰を得たので報告する．
Kanda et al. (Fri,) conducted a case report in Type non-A non-B acute aortic dissection with malperfusion syndrome (n=1). Thoracic endovascular aortic repair (TEVAR) and endovascular therapy (EVT) was evaluated on Organ reperfusion and avoidance of bowel resection. Early TEVAR combined with EVT achieved rapid organ reperfusion and avoided bowel resection in a patient with acute type non-A non-B aortic dissection complicated by malperfusion syndrome.