腹主动脉夹层的诊断和治疗现状

Current status of diagnosis and treatment of abdominal aortic dissection

腹主动脉夹层(AAD)是一种罕见的严重主动脉疾病,好发于男性,与吸烟、高血压、高脂血症关系密切。患者临床表现呈多样性,或无明显症状,容易导致误诊、漏诊,延误治疗。增强CT是诊断AAD的首选。初始治疗多采取保守治疗,通过药物治疗严格控制血压和心率,并结合影像学随访。当疾病进展出现手术指征时,应积极采取手术治疗。主动脉覆膜支架腔内修复术是AAD的首选的手术方式,开放手术多用于病变解剖学条件不适合腔内修复术的患者。腔内修复术难度较高,详细的术前评估,制定合理的手术方案是腔内修复术成功的关键。

Abdominal aortic dissection(AAD)is a rare and severe aortic disease that usually occurs in men and is closely associated with smoking,hypertension and hyperlipidemia.The clinical manifestations are diverse or even absent;which may easily lead to misdiagnosis,missed diagnosis and delayed treatment.Enhanced CT is the first choice for the diagnosis of AAD.Conservative treatment to control the blood pressure and heart rate combined with imaging follow-up is the most common initial treatment.When AAD progresses and has surgical indication,surgery treatment should be performed actively.Endovascular aortic repair(EVAR)is the first surgical choice.Open surgery is often used in patients with anatomic conditions that are not suitable for EVAR.A detailed preoperative evaluation and an appropriate operation plan are essential for the success of EVAR.