Celiac Artery Aneurysm Due to Chronic Spontaneous Dissection: Two Cases of Surgical Repair

In this report, we describe two surgical cases of celiac artery aneurysm due to chronic and asymptomatic spontaneous dissection without atherosclerotic change or medial degeneration. Case 1 had replacement of the celiac and common hepatic arteries using a knitted Dacron prosthetic graft, and case 2 had simple aneurysmectomy. The incidence of celiac artery dissection is increasing lately, but subsequent aneurysm is relatively rare. Our two cases had no atherosclerotic risk factors, so it might be possible that celiac artery aneurysm due to spontaneous dissection may produce different findings from dissection of other arteries. We consider that the need for surgery should be determined carefully if the asymptomatic celiac artery aneurysm due to dissection is small and unless it shows any changes in its diameter in the follow-up period.

Reconstructive treatment of symptomatic vertebral artery dissecting aneurysms with Willis covered stent: Initial experience

Background:Symptomatic vertebral artery dissecting aneurysm(VADA)is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature.Moreover,the outcomes of reconstructive treatment have not been well established.Objective:To evaluate the safety and efficacy of reconstructive endovascular treatment(EVT)for symptomatic VADAs with Willis covered stent.Methods:We evaluated retrospectively 13 patients with symptomatic VADAs who treated with Willis covered stent,compared with stent-assisted coiling(SAC)on the characteristics,posttreatment course,angiographic and clinical follow-up outcomes at an average of 14.4 months(range,3-48 months).Results:A total of 33 patients with symptomatic VADAs were reviewed,23 of these patients with ruptured VADAs.The technical successful rate is 100%respectively in Willis covered stent(Group A)and SAC(Group B,n=20).The initial complete occlusion rate was significant higher in group A(100%)than group B(30%)(p<0.01).Major procedure-related complications were not significant different in the two groups.Serial follow-up angiograms revealed 5 recurrent VADAs in group B and no recurrence in group A(p>0.05).No obvious in-stent stenosis and no re-hemorrhage and delayed ischemic symptoms during the follow-up period.The final angiograms of all survived patients demonstrated the complete occlusion rate was higher in group A(100%)than group B(80%),but no significant statistical difference(p>0.05).Clinical outcomes were favorable in 31(93.9%),severe disability occurred in one in group B,and only one death in group A.The final clinical outcomes were also not significant difference in the two groups(p>0.05).Conclusions:Our initial result demonstrated reconstructive EVT with Willis covered stent provides a viable approach for selected symptomatic VADAs involving the intracranial and extracranial segments,which is similar to favorable results with SAC.However,an expanded clinical experiences and larger cohort studies are needed.

Treatment of extracranial internal carotid artery dissecting aneurysm with SUPERA stent implantation:Two case reports

BACKGROUND There is no standard endovascular treatment for extracranial internal carotid artery dissecting aneurysms.In the past,stent-graft isolation and stent-assisted coil embolization were commonly used for wide-necked and fusiform aneurysms.Here,we present two cases of extracranial internal carotid artery dissecting aneurysms treated successfully using the SUPERA stent.CASE SUMMARY Case 1 was a 57-year-old male patient with sudden right limb weakness and vague speech and diagnosed with cerebral infarction in February 2019.Cervical computed tomographic angiography(CTA)revealed left internal carotid artery dissection with stenosis.CTA at 2 mo showed an eccentric wide-necked dissecting aneurysm(5 mm×5 mm×12 mm,10-mm neck)that was enlarged at 4 mo(7 mm×6 mm×12 mm,11-mm neck).The patient underwent SUPERA stent implantation.His condition was stable in July 2020.Case 2 was a 57-year-old man who suddenly felt dizzy and developed unsteady walking in November 2019.Cervical CTA suggested right internal carotid artery dissecting aneurysm(11 mm×9 mm×31 mm)complicated with severe lumen stenosis(95%).The patient underwent SUPERA stent implantation.The patient had no residual symptoms and was stable in December 2020.CONCLUSION SUPERA stent implantation might achieve good results in treating wide-necked or long fusiform internal carotid artery dissecting aneurysms.

Surgical repair of an emergent giant hepatic aneurysm with an abdominal aortic dissection:A case report

BACKGROUND Hepatic artery aneurysm(HAA)is the second most common visceral aneurysm.A significant number of hepatic aneurysms are found accidentally on examination.However,their natural history is characterized by their propensity to rupture,which is very serious and requires urgent treatment.An emergent giant hepatic aneurysm with an abdominal aortic dissection is less commonly reported.CASE SUMMARY We report the complicated case of a giant hepatic aneurysm with an abdominal aortic dissection.A 66-year-old female presented with the complaint of sudden upper abdominal pain accompanied by vomiting.Physical examination showed that her blood pressure was 214/113 mmHg.Her other vital signs were stable.Computed tomography found a giant hepatic proper aneurysm and dissection of the lower segment of the abdominal aorta.Furthermore,angiography showed a HAA with the maximum diameter of approximately 56 mm originating from the proper hepatic artery and located approximately 15 mm from the involved bifurcation of the left and right hepatic arteries with no collateral circulation.Therefore,we decided to use a stent to isolate the abdominal aortic dissection first,and then performed open repair.After the operation,the patient recovered well without complications,and her 3-month follow-up checkup did not reveal any late complications.CONCLUSION Open surgery is a proven method for treating giant hepatic aneurysms.If the patient's condition is complex,staged surgery is an option.

Vocal Cord Paralysis Secondary to Carotid Artery Dissection: A Case Report

Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure. We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection. Method: The diagnosis was based on clinical history, physical examination and imaging studies. Literature review was done. Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies. Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up. Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve. Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology. Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.

Pancreaticoduodenal artery aneurysm associated with coeliac artery occlusion from an aortic intramural hematoma

Pancreaticoduodenal artery aneurysms are a rare type of visceral artery aneurysm, whose rupture is associated with high mortality. These aneurysms are of particular interest because local haemodynamic change caused by coeliac artery obstruction plays an important role in their development. However, the pathophysiological mechanism of coeliac artery obstruction is not completely understood. Pressure from the median arcuate ligament is most frequently reported cause. Although it is well-known that stenosis or occlusion of the visceral vessels may be caused by aortic syndrome, reports of pancreaticoduodenal artery aneurysm associated with coeliac artery occlusion due to aortic syndrome are extremely rare. Our case indicates a new aetiology for a pancreaticoduodenal artery aneurysm and demonstrates the rapid deterioration of the patient affected.

Segmental arterial mediolysis: A clinical-pathologic review, its role in fibromuscular dysplasia and description and differential diagnosis of the masquerader-muscular artery cystic necrosis

Segmental arterial mediolysis (SAM) is an uncommon non-inflammatory iatrogenic arteriopathy caused by alpha-1 adrenergic agonists or Beta-2 agonists able to release norepinephrine from the peripheral nervous system. Causative agents include adrenergic agonists used to control blood pressure, B-2 tocolytic agonists, and ractopamine used as a repartitioning agent in animal husbandry. The liberated norepinephrine both injures and stimulates a robust reparative response in the muscular arteries in the abdomen, brain base, and coronary arteries. This response may be augmented by endothelin-1 formed in the arterial adventitia. Three types of arterial lesions develop in the injurious stage: 1) apoptotic induced mediolysis, 2) separation of the outer media from the adventitia and 3) the formation of arterial gaps. The latter enlarge, particularly in elderly patients, to form gap-aneurysms complicated by dissections and dissecting an- eurysms that when ruptured cause the calamitous hemorrhages that clinically announce SAM. The other types of injury remain clinically silent but with repair develop sequelae and can metamorphose into fibromuscular dysplasia. The sequelae are mainly asymptomatic but may cause arterial stenosis and ischemic lesions. The definitive diagnosis of SAM re- quires histological conformation but misinterpreta- tion of smooth muscle vacuolar change has caused di- agnostic errors. Muscular artery cystic necrosis a newly named non-inflammatory muscular artery ar- teriopathy may be confused with SAM both clinically and pathologically. This arteriopathy represents the muscular artery equivalent of cystic media necrosis of the elastic arteries since it exhibits similar morphol- ogic features and can occur concomitantly with this entity. Adrenergic agents to counter hemorrhagic shock in SAM are contraindicated since they may intensify injury and create new lesions. The use of norepinehrine antagonists introduces a new, but as yet untested, treatment option for SAM.

Endovascular Management of Vertebral Artery Aneurysms

Background: The management outcome of a series of ruptured vertebral artery (VA) aneurysms was reviewed. Method: This is a retrospective study of prospectively collected data of 60 cases with ruptured VA aneurysms in the author’s database from the year 2004. All cases were managed with coiling, stent-assisted coiling, flow diversion or endovascular parent artery sacrifice. Nimodipine and hypertensive, hypervolemic therapy was applied as standard. Outcome was assessed at 6 months with modified Rankin score (mRS). Results: There were 26 females and 34 males. Age range is 18 to 70 with a mean age of 42. There were 27 dissecting aneurysms and 33 saccular aneurysms. 50 (83%) cases were World Federation of Neurological Surgeons (WFNS) grade one to three. There were four WFNS grade four and six WFNS grade five. 25 cases of dissecting aneurysms were managed with parent artery coil occlusion. Two dissecting aneurysms affecting the dominant VA were treated with flow diverters. At 6 months follow up 50 (83%) achieved good outcome with mRS one to two. There were eight cases with poor outcome and two deaths. Six-month follow-up MR angiogram documented stable occlusion for the 24 cases with dissecting aneurysms treated with parent artery coil occlusion who survived. The two treated with flow diversion demonstrated good remodelling at 6 months on angiography. Six-month follow-up angiogram for the 32 cases of saccular aneurysm who survived documented stable aneurysm obliteration. Conclusion: Good outcome can be achieved with endovascular treatment for ruptured VA aneurysms. Parent artery occlusion is a safe and effective technique for ruptured VA dissecting aneurysm.

血管内治疗小脑后下动脉瘤24例临床经验

目的 探讨血管内治疗小脑后下动脉(PICA)瘤的治疗策略、安全性及临床疗效。方法 回顾性分析安徽医科大学第一附属医院2017年7月至2022年1月行血管内治疗的24例PICA动脉瘤病人的临床资料(其中,PICA近端13例、过渡段1例、远端10例;以蛛网膜下腔出血首诊的21例、未破裂动脉瘤3例),单纯栓塞12例、动脉瘤及载瘤动脉闭塞7例(闭塞材料使用弹簧圈3例、Onyx胶4例)、支架辅助弹簧圈栓塞5例。术后随访3~24个月。结果 24例PICA动脉瘤病人术中动脉瘤均栓塞顺利。23例病人无近期并发症,1例出血病人合并严重脑血管痉挛自动出院(临床预估死亡)。随访结果:19病人远期随访无复发;4例复发,其中2例二期行支架辅助栓塞,后期随访良好、未再复发;1例首次支架辅助栓塞病人再次行穿支架网孔弹簧圈单纯栓塞,后期随访良好、未再复发;1例首次单纯栓塞病人再次行弹簧圈栓塞,后期随访良好、未再复发。结论 血管内治疗PICA动脉瘤安全、可行,疗效可靠。根据动脉瘤血管解剖位置,对于破裂出血的PICA动脉瘤首次治疗倾向单纯栓塞或载瘤动脉闭塞术。首次单栓病例术后复发,可二期行支架辅助栓塞能取得满意效果。对于复发动脉瘤经再次血管内治疗可获得满意效果。

评估血清Tenascin-C作为急性主动脉夹层动脉瘤患者生物标志物的临床研究

目的肌腱蛋白C(Tenascin-C,TNC)与心血管疾病的不良预后和重大心血管事件的发生有关。本研究旨在评估TNC在作为急性主动脉夹层动脉瘤(AAD)生物标志物方面的价值。方法回顾性纳入2021年5月至2022年3月于新疆维吾尔自治区人民医院心脏及泛血管医学诊疗中心心脏外一科接受治疗的120例AAD患者(AAD组,Stanford A型或B型,均在突发疼痛症状后24 h内入院),另选同时期107例颈动脉狭窄(CAS)患者作为CAS组,120例健康志愿者作为正常对照组。术前、急诊开胸手术后第1、3、7、14 d检测AAD组患者血清TNC水平,与另外两组血清进行比较。主要研究终点为术后60 d短期生存结局。结果与正常对照组相比,AAD组患者术前血清TNC水平显著升高(P<0.001),且StanfordA型患者术前血清TNC水平较B型患者更高(P<0.05)。术后第3 d,AAD组患者血清TNC水平较术前下降(P<0.05),术后第14 d时与正常对照组比较,差异无统计学意义[119.26(71.31,157.14)pg/ml vs.117.83(84.04,134.07)pg/ml,Z=-0.873,P=0.383]。与正常对照组比较,CAS组患者血清TNC水平显著升高(P<0.001),且与颈动脉狭窄程度呈正相关(r=0.279,P=0.004)。根据受试者工作特征曲线,术前血清TNC预测AAD的曲线下面积(AUC)为0.731;预测CAS的AUC为0.671。血清TNC可良好区分AAD患者和CAS患者,AUC为0.816。23例AAD患者术后60 d内死亡,根据术前血清TNC水平ROC曲线临界值(172.74pg/ml)分层,AAD患者的短期生存率与术前血清TNC水平有关(logrank=3.706,P=0.047)。结论血清TNC水平可作为急性主动脉夹层动脉瘤潜在的诊断和预后生物标志物。

B型主动脉夹层患者TEVAR术中应用股动脉穿刺预置缝合技术与股动脉切开技术的效果对比分析

目的:对比在B型主动脉夹层患者胸主动脉腔内修复术(Thoracic Endovascular Aneurysm Repair,TEVAR)术中应用股动脉穿刺预置缝合技术与股动脉切开技术的效果。方法:回顾性收集2020年4月至2023年4月期间于本院血管外科行TEVAR术治疗的137例B型主动脉夹层患者的临床资料。根据手术方式不同,将患者分为切开组(采用股动脉切开术,68例)和缝合组(采用股动脉穿刺预置缝合术,69例)。分析比较两组的手术指标及康复情况、生活质量及并发症(术后住院期间)发生情况。结果:缝合组的手术时间、术后下床活动时间及住院时间均显著短于切开组,术中出血量显著少于切开组(P<0.05)。缝合组术后6 m及1 y的生活质量评分均显著高于切开组(P<0.05)。两组的术后并发症发生率无显著差异(P>0.05)。结论:与股动脉切开技术比较,EVAR术中应用股动脉穿刺预置缝合技术可缩短B型主动脉夹层患者手术时间、术后下床活动时间及住院时间,减少术中出血量,改善生活质量,且安全性较高。

血流导向装置治疗椎动脉夹层动脉瘤疗效分析

目的探讨Pipeline血流导向装置(pipeline embolization divice,PED)治疗椎动脉夹层动脉瘤(vertebral artery dissecting aneurysm,VADA)的安全性及疗效。方法回顾性收集2019年1月至2023年6月新疆医科大学第一附属医院神经外科采用PED治疗的21例VADA患者的临床资料,记录手术方式、围手术期并发症、影像学结果并进行随访。以改良Rankin量表评分(mRS)评估患者预后,影像学随访采用Kamran分级。结果21例患者中未破裂动脉瘤17例,破裂动脉瘤4例。共置入22枚PED,其中13例患者接受单纯PED置入,8例患者接受PED联合弹簧圈栓塞,技术成功率21/21。3例破裂动脉瘤患者近端合并有狭窄,1例患者狭窄率>50%,因此额外放置了1枚Solitaire支架进行支架内后扩张。术后即时Kamran分级1级16例,2级1例,3级4例。围手术期并发症2例,1例患者发生动脉瘤术后破裂,1例患者肺部重症感染最终死亡。出院时mRS评分1分15例,2分2例,3分1例,4分1例,6分2例。18例患者获得随访,中位随访时间为12.5(6~30)个月,其中mRS评分0分13例,1分4例,2分1例;Kamran分级2级2例,3级4例,4级12例。结论采用PED治疗VADA手术成功率高、安全性好,但围手术期并发症不可忽视,未来仍需大量样本进一步研究。

血管内治疗椎动脉夹层动脉瘤的疗效分析

目的对椎动脉夹层动脉瘤(VADA)进行血管内治疗的安全性和有效性进行综合分析。方法回顾性纳入2020年1月至2022年12月期间在苏州大学附属第一医院神经外科接受血管内治疗的45例颅内段椎动脉夹层动脉瘤患者,收集一般资料和临床资料,其中一般资料包括年龄、性别和血管危险因素等,临床资料包括动脉瘤的基本特征(动脉瘤的长径、是否位于椎动脉优势侧、与同侧小脑后下动脉的关系)、治疗结果和随访资料等。随访资料包括CT血管成像(CTA)和/或数字减影血管造影(DSA)等影像学资料以及门诊及电话进行的临床预后资料。术后6个月进行脑血管造影术,随后每1-2年进行影像学及临床随访。结果在45例椎动脉夹层动脉瘤患者中,方案包括载瘤动脉闭塞治疗3例、单纯支架置入术2例、支架辅助弹簧圈栓塞治疗28例、密网孔支架置入术12例。2例VADA破裂患者(均累及小脑后下动脉)行支架辅助弹簧圈栓塞治疗,术后1周内因动脉瘤再次破裂而死亡,死亡率为4.4%。42例患者完成了术后6个月的影像学(DSA)随访,随访时间为6-12个月,中位随访时间为7个月。DSA随访结果显示,38例患者动脉瘤治愈(占90.5%),4例改善(9.5%);43例患者完成了术后6个月的临床随访,结果显示43例(100%)患者均预后良好。结论以上数据表明,VADA患者采用血管内治疗方案安全、有效,但该结论还需在更大规模的队列中进一步验证。

Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique： Technical Note

Background： The endovascular strategy of the huge dissecting aneurysms involving the basilar artery （BA） is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping （IT） technique. Methods： We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results： All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months alter the endovascular treatment （median 8 months）, 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions： The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

Dissecting aneurysms of the distal segment of the posterior cerebral artery: clinical presentation and endovascular management

Backgroud:We aimed to evaluate the clinical presentations and report the acceptable clinical and angiographic outcome of the distal posterior cerebral artery (PCA) dissecting aneurysms with parent artery occlusion (PAO).Methods:From June 2006 to July 2013,26 patients with PCA dissecting aneurysms were planned to be treated via endovascular PAO in our institution.Fourteen patients had ruptured aneurysms,and twelve patients had unruptured aneurysms.The endovascular modalities were the following:1) PAO (n =19),2) palliative embolization (n =5),and 3) proximal PAO (n =2).Glasgow Outcome Scale (GOS) was used to assess the clinical outcome.Results:The procedure was technically successful in all cases.In the PAO and proximal PAO group,all of the immediate angiography showed occlusion of the parent vessel,and follow-up imaging showed no recurrence of the aneurysms.In the palliative embolization group,one of five patients was died of rebleeding after the procedure,and follow-up digital subtraction angiography (DSA) showed the other four aneurysms recurred.Five procedure related complications occurred totally:rebleeding (n =1),hemiparesis (n =2),and hemianopsia (n =2).Conclusion:Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and a thorough treatment is warranted.Sacrificing the parent artery appears to be well tolerated for distal segment of PCA.We propose that this technique could be the first treatment option in treating dissecting aneurysms in this location.However,palliative occlusion of distal PCA dissecting aneurysms is not an advisable treatment option.

Treatment Strategy for Middle Cerebral Artery Dissecting Aneurysm with Severe Stenosis

A 62-year-old male patient was presented to the First Affiliated Hospital,Zhejiang University,School of Medicine with right hemiparesis and aphasia.No obvious infections were found.The magnetic resonance imaging demonstrated multiple infarctions in the area supplied by the left middle cerebral artery.The diagnosis was made as left middle cerebral artery dissecting aneurysm with stenosis.After adequate preoperative preparation,the patient received interventional therapy and then exhibited good prognosis.This paper introduces the interventional procedures for the treatment of the left middle cerebral artery dissecting aneurysm with stenosis.

椎基动脉夹层动脉瘤支架应用探讨

目的探讨椎基动脉夹层动脉瘤支架应用的价值。方法12例椎基夹层动脉瘤,其中椎动脉3例,椎基动脉6例,基底动脉3例。2例动脉瘤位于小脑后下动脉处,各置入2枚支架,重叠在动脉瘤段载瘤动脉内,10例经支架网眼送入弹簧圈。结果12例置入支架16枚,7例填塞致密,3例疏松填塞,栓塞临床症状消失。6例在术后分别随访6～48个月,脑血管造影复查见动脉瘤消失。但有2例出现新的动脉瘤,1例在置入支架上段出现夹层动脉瘤,再次置入支架和1枚弹簧圈栓塞,动脉瘤消失,1例在原动脉瘤对侧动脉壁出现动脉瘤,再置入1枚支架重叠在原支架内,造影动脉瘤血液循环慢。2例小脑后下动脉夹层动脉瘤,24个月造影复查见动脉瘤缩小70%,小脑后下动脉瘤循环良好。其余4例因无症状不同意复查血管造影,遂行MRA、CTA检查,未见动脉瘤复发。结论支架辅助弹簧圈治疗椎基夹层动脉瘤是行之有效的方法。

血管内治疗椎动脉夹层动脉瘤18例

目的 探讨椎动脉夹层动脉瘤的发病机制,评价血管内治疗椎动脉夹层动脉瘤的技术方法及临床疗效。方法 应用血管内治疗技术对18例椎动脉夹层动脉瘤的患者进行诊断、治疗,回顾性分析临床资料、血管内治疗经过以及临床疗效。 结果 18例患者中有6例直接闭塞动脉瘤和载瘤动脉,7例行支架辅助弹簧圈栓塞,4例行双支架置入术,1例单纯闭塞载瘤动脉。术后12例患者接受随访,随访时间为3个月至2年,平均8个月。随访期间曾经有过蛛网膜下腔出血的7例患者临床症状减轻或消失,没有再出血,2例术后临床症状未见改善。18例患者中3例死亡。 结论 血管内治疗椎动脉夹层动脉瘤最有效的方法,是将载瘤动脉连同动脉瘤完全闭塞,如果动脉瘤位于优势椎动脉,或对侧椎动脉发育不良甚至闭塞,或动脉瘤瘤体发出优势小脑后下动脉,应该使用支架血管成形辅助弹簧圈填塞动脉瘤或双支架置入技术。

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

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。

胸主动脉夹层动脉瘤腔内隔绝术中左锁骨下动脉的处置

目的 :探讨腔内隔绝术治疗 Stanford B型胸主动脉夹层动脉瘤时左锁骨下动脉开口的处理原则。方法 :对 116例接受腔内隔绝术治疗的 Stanford B型胸主动脉夹层动脉瘤患者进行回顾性分析。 结果 :116例患者中 6 2例左锁骨下动脉开口受到干扰 ,其中 2例完全遮蔽 ,19例有临床症状 ,而术前行颈外动脉 -椎动脉旁路者 ,完全遮蔽左锁骨下动脉后无不适症状。结论 :完全遮蔽左锁骨下动脉可引起左侧椎动脉的急性严重缺血造成严重的并发症 ,术前应根据夹层破口与左锁骨下动脉开口的距离 ,选择性实施左锁骨外动脉 -左椎动脉旁路术。