急性Stanford A型主动脉夹层合并肠系膜上动脉灌注不良的治疗现状

Current management of acute Stanford type A aortic dissection complicated with mesenteric malperfusion

一直以来,合并肠系膜上动脉灌注不良的急性Stanford A型主动脉夹层的治疗极具挑战性,死亡率高,预后差,当前对这一危急重症的治疗策略缺乏一致性意见。急诊开放升主动脉修复是传统经典的抢救性处置策略,但具有较高的死亡率和并发症发生率。近些年来通过主动脉腔内治疗优先恢复肠系膜上动脉灌注的治疗策略亦受到关注并有相应报道,其他还包括单纯主动脉腔内治疗和内科保守治疗。各种策略都存在很多亟待解决的问题,最优治疗策略仍存在争议,尚需进一步调查与研究。本文就这些问题进行阐述。

The management of acute type A aortic dissection(aTAAD)with mesenteric malperfusion(MMP)is quite challenging as it is often associated with high mortality and poor outcomes,and an optimal treatment strategy is lack of consensus for this critically ill condition.Emergent open surgical repair of the ascending aorta is a life-saving operation and remains the standard of care for aTAAD with MMP,but is associated with a high rate of mortality.In recent years,reperfusion of superior mesenteric artery(SMA)by endovascular repair as the first treatment strategy in the treatment of aTAAD with MMP has been concerned and reported.Only endovascular repair and conservative medical treatment are also introduced in few cases with poor outcomes.There are many urgent issues that need to be addressed in current strategies.The optimal management strategies remain controversial,and further investigation and research are needed.These issues were addressed in this article.