Key result
TEVAR before total arch replacement resolves mesenteric malperfusion and enables survival in acute type A dissection.
Why the study?
Does endovascular repair prior to total aortic arch replacement improve outcomes in a patient with Stanford type A acute aortic dissection and abdominal organ ischemia?
Case Report (n=1)
No
Does endovascular repair prior to total aortic arch replacement improve outcomes in a patient with Stanford type A acute aortic dissection and abdominal organ ischemia?
Endovascular repair prior to surgical central repair may be an effective strategy for managing Stanford type A acute aortic dissection complicated by severe abdominal organ ischemia.
Staged endovascular visceral reperfusion before arch repair may stabilize malperfusion in select type A dissections; leaves open broader efficacy.
症例は 47歳男性.自宅で胸背部痛を自覚し当院に救急搬送された.胸腹部造影 CT検査で StanfordA型急 性大動脈解離と診断された.腹腔動脈は血流をみとめず上腸間膜動脈も血流は遅延していた.心嚢液は少量 で循環動態は安定していたが代謝性アシドーシスが進行して臓器虚血が疑われたため central repairに先行 し血管内治療による腹部分枝の血行再建を行い,その後大動脈全弓部人工血管置換術を施行した.術後一時 的に対麻痺を認めスパイナルドレナージと血圧を昇圧することで回復し術後第 68病日独歩退院となった. 臓器虚血を伴う StanfordA型急性大動脈解離に対し血管内治療を先行させ,良好な結果を得たため文献的 考察を含めて報告する.日心外会誌 48巻 2号:138-141(2019) キーワード:Stanford A 型急性大動脈解離;malperfusion;central repair;PETTICOAT technique
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Endo et al. (2019) conducted a case report in Stanford type A acute aortic dissection with abdominal organ ischemia (n=1). Endovascular repair (TEVAR/PETTICOAT technique) prior to total aortic arch replacement was evaluated. Endovascular repair prior to total aortic arch replacement successfully resolved mesenteric malperfusion and allowed for survival in a patient with Stanford type A acute aortic dissection.
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