合并迷走右锁骨下动脉的主动脉夹层4例报告并文献复习

Endovascular repair for aortic dissecting aneurysm combined with aberrant right subclavian arteries

目的分析合并迷走右锁骨下动脉(ARSA)主动脉夹层的临床和影像学特点,总结腔内治疗该病的成功经验。方法回顾性分析4例合并ARSA的主动脉夹层动脉瘤患者的临床、影像和手术资料。结果4例合并ARSA的主动脉夹层患者均有后背部撕裂样剧痛,其中1例伴有上腹部疼痛。CT检查发现4例主动脉夹层第一裂口与右迷走右锁骨下动脉关系均较近或位于后者之内,主动脉真腔变窄。根据第一裂口解剖位置的不同分别采取了4种腔内修复治疗方案,手术均获得成功。结论合并迷走右锁骨下动脉的主动脉夹层临床罕见,其腔内治疗应根据第一裂口的解剖位置进行个性化设计,采用不同的血管腔内治疗方案可提高手术成功率。

Objective To study the clinical and image features of the aortic dissecting aneurysm （AD） combined with aberrant right subclavian arteries （ARSA）, and to discuss the feasibility of endovascular repair for such disorder. Methods The clinical and image data of 4 patients, who suffered from AD combined with ARSA and admitted in the authors＇ service during 2004 to 2007, were retrospectively reviewed. All the 4 cases complained severe aches in their back, and one of them was companied with aches in upper abdomen. CT-exam showed that the first tear （gap） of AD located near or inside ARSA, the truncus aortae narrowed obviously. Four operational prescriptions were performed respectively for the 4 patients depending on the location of gaps and on the distance between the gap and ARSA. Results All the 4 cases received satisfy operation. A slight early leakage occurred in the first case without steal syndrome, and the lower blood pressure was 80 mmHg on right arm; for the second case, no leakage occurred with normal blood presser on both arms; for the third one a slight early leakage was companied with normal blood presser on both arms and for the fourth one a slight early leakage occurred without steal syndrome, and the lower blood presser was 60mmHg on right arm. Conclusion AD combined with ARSA is a rare case in clinic. The modus operandi of endovascular repair should be designed based on the situation of individual case considering the location of the first tear. Once the target area exposed is not wide enough for operation, subclavian artery bypass would be a right way in reduction of leakage complications and in increasing the opportunity for a successful operation.